Pahl E, Naftel D C, Canter C E, Frazier E A, Kirklin J K, Morrow W R
Heart Transplantation, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
J Heart Lung Transplant. 2001 Mar;20(3):279-87. doi: 10.1016/s1053-2498(00)00228-x.
Rejection with severe hemodynamic compromise results in high mortality in adult transplant patients. This study determines the incidence, outcome and risk factors for rejection with severe hemodynamic compromise in a multi-institutional study of pediatric heart transplant recipients.
Data from 847 patients transplanted between 1/1/93 and 12/31/98 at 18 centers in the Pediatric Heart Transplant Study were analyzed. Rejection with severe hemodynamic compromise was defined as a clinical event occurring beyond 1 week postoperatively, which led to augmentation of immunosuppression and use of inotropic therapy. Actuarial freedom from such rejection and death after rejection were determined and risk factors sought.
Among 1,033 rejection episodes in 532 patients, 113 (11%) episodes were associated with severe hemodynamic compromise in 95 patients. The highest risk for severe rejection was in the first year. Risk factors were older recipient age (p >.05) and non-white race (p >.001). Survival after an episode was poor (60%), and biopsy score did not affect outcome. Deaths were due to rejection (n = 14), other cardiac causes (n = 17), infection (n = 5), lymphoma (n = 2), pulmonary causes (n = 2), and thrombosis (n = 1).
Rejection with severe hemodynamic compromise occurs in 11% of pediatric patients, irrespective of age, sex or biopsy score, and mortality is high. Non-white race and older recipient age are independent risk factors for rejection with severe hemodynamic compromise. Aggressive treatment and close surveillance should be crucial components of protocols aimed at reducing the high mortality.
严重血流动力学损害的排斥反应会导致成年移植患者的高死亡率。本研究在一项针对小儿心脏移植受者的多机构研究中，确定严重血流动力学损害的排斥反应的发生率、结局及危险因素。
分析了1993年1月1日至1998年12月31日期间在小儿心脏移植研究的18个中心接受移植的847例患者的数据。严重血流动力学损害的排斥反应被定义为术后1周后发生的临床事件，该事件导致免疫抑制增强和使用了正性肌力药物治疗。确定了免于此类排斥反应和排斥反应后死亡的精算生存率，并寻找危险因素。
在532例患者的1033次排斥反应发作中，95例患者的113次（11%）发作与严重血流动力学损害有关。严重排斥反应的最高风险在第一年。危险因素为受者年龄较大（p>.05）和非白种人（p>.001）。一次发作后的生存率较差（60%），活检评分不影响结局。死亡原因包括排斥反应（n = 14）、其他心脏原因（n = 17）、感染（n = 5）、淋巴瘤（n = 2）、肺部原因（n = 2）和血栓形成（n = 1）。
11%的小儿患者会发生严重血流动力学损害的排斥反应，与年龄、性别或活检评分无关且死亡率很高。非白种人和受者年龄较大是严重血流动力学损害的排斥反应的独立危险因素。积极治疗和密切监测应是旨在降低高死亡率的方案的关键组成部分。
