Rebocho M J, Aguiar C, Queiroz e Melo J
Serviço de Cirurgia Cardiotorácica, Hospital de Santa Cruz, Carnaxide, Portugal.
Rev Port Cardiol. 2001 Mar;20 Suppl 3:67-74.
To evaluate the morbidity and mortality after heart transplantation in the patients treated at Santa Cruz Hospital.
Between February 1986 and December 2000, 113 patients underwent orthotopic heart transplantation at Santa Cruz Hospital. Actuarial survival rates at 12 months, 5 and 10 years after surgery were calculated (Kaplan-Meier analysis). We identified the causes of death and evaluated their relation with time after transplantation. Quality of life after surgery was assessed by functional status and employment status. Main causes of morbidity were identified: infection, rejection, tumors, allograft vasculopathy and side effects of chronic immunosuppression.
Eighty-one patients (71.7%) were discharged alive after transplantation. In this group, actuarial survival was 82.2% at 12 months, 64.6% at 5 years and 45.3% at 10 years. Maximal survival was 14.7 years. In the immediate postoperative period, the main causes of mortality were procedure-related ou primary cardiac complications. Infection was the most common cause of death in the first 3 months after transplantation. Allograft vasculopathy was the main cause of death in the group of patients surviving the first year. Malignancy was another cause of late mortality. Clinically relevant non-fatal infections occurred in 35.4% of our patients. Overall, 108 mild rejection episodes were diagnosed in 55 patients, 82 moderate rejection episodes in 52 patients and 9 severe rejections in 8 patients. Eleven non-fatal tumors were detected in 10 patients. In the group of patients who have underwent at least one coronary arteriography, 34.6% present allograft vasculopathy. Clinically relevant complications of chronic immunosuppression were: hypertension in 50% patients; dyslipidemia in 31%; osteoporosis in 19.5%; diabetes mellitus in 15%; end-stage renal failure in 3.5%.
Cardiac transplantation is a valid treatment for end-stage heart failure. Most patients surviving long-term are in good physical status and their quality of life is comparable to that of the general population.
评估在圣克鲁斯医院接受治疗的患者心脏移植后的发病率和死亡率。
1986年2月至2000年12月期间，113例患者在圣克鲁斯医院接受了原位心脏移植。计算术后12个月、5年和10年的精算生存率（Kaplan-Meier分析）。我们确定了死亡原因，并评估了它们与移植后时间的关系。通过功能状态和就业状态评估术后生活质量。确定了发病的主要原因：感染、排斥反应、肿瘤、同种异体移植血管病变和慢性免疫抑制的副作用。
81例患者（71.7%）移植后存活出院。在该组中，12个月时的精算生存率为82.2%，5年时为64.6%，10年时为45.3%。最长生存期为14.7年。术后即刻，死亡的主要原因是与手术相关或原发性心脏并发症。感染是移植后前3个月最常见的死亡原因。同种异体移植血管病变是存活第一年患者组的主要死亡原因。恶性肿瘤是晚期死亡的另一个原因。35.4%的患者发生了临床相关的非致命感染。总体而言，55例患者诊断出108次轻度排斥反应，52例患者诊断出82次中度排斥反应，8例患者诊断出9次重度排斥反应。10例患者检测到11例非致命肿瘤。在至少接受过一次冠状动脉造影的患者组中，34.6%存在同种异体移植血管病变。慢性免疫抑制的临床相关并发症为：50%的患者患有高血压；31%患有血脂异常；19.5%患有骨质疏松症；15%患有糖尿病；3.5%患有终末期肾衰竭。
心脏移植是终末期心力衰竭的有效治疗方法。大多数长期存活的患者身体状况良好，其生活质量与普通人群相当。
