Marelli Daniel, Laks Hillel, Kobashigawa Jon A, Bresson Jessica, Ardehali Abbas, Esmailian Fardad, Plunkett Mark D, Kubak Bernard
Heart Transplant Program, University of California, Los Angeles, USA.
Ann Thorac Surg. 2002 Nov;74(5):1558-66; discussion 1567. doi: 10.1016/s0003-4975(02)03933-4.
Heart transplantation is the most accepted treatment for end-stage heart disease. A review of 1,083 consecutive transplants (1984 to 2001) was undertaken.
Adult recipients were divided into quartiles. The last 540 transplants were combined. Three eras were created from these, 1984 to 1991, 1991 to 1995, and 1995 to 2001, with three age groups: 0 to 18 years, 19 to 61 years, and 62 to 74 years. All patients have at least 1 year of follow-up time. End points were survival, rejection, and graft coronary artery disease.
There were 1,012 patients. Donor age, graft ischemic time, and the proportion of elderly recipients and nonstandard donor hearts have increased in the current era. Actuarial 60-month survivals of recipients after 1995 were 80.7% (0 to 18 years); 75.3% (19 to 61 years); and 76.2% (>62 years). The current era children and younger adult groups demonstrated improved results when compared with previous eras (p = 0.003 and p = 0.05). Rejection episodes equal to or greater than ISHLT grade 3A per person per year improved to 0.15 in the current era (p < 0.001). During the three eras, older recipients (>62 years) demonstrated fewer episodes of rejection when compared with other adults (0.13 versus 0.58, p = 0.03). Deaths attributed to graft coronary artery disease decreased from 11% to 5% from era 2 to era 3. Regression analysis revealed a mild effect of donor age on survival and graft coronary artery disease (hazard ratio = 1.02, p = 0.001; hazard ratio = 1.039, p < 0.001, respectively). Recipient predictors of graft coronary artery disease were diagnosis of ischemic cardiomyopathy (hazard ratio = 1.6, p = 0.014) and congenital heart disease (hazard ratio = 3.41, p = 0.02).
Improved survival in the current era may be attributed to better organ preservation, improved immunosuppression and control of infection, and less life-threatening graft coronary artery disease.
心脏移植是终末期心脏病最被认可的治疗方法。我们对1984年至2001年连续进行的1083例移植手术进行了回顾。
成年受者被分为四分位数。将最后540例移植手术合并。从这些手术中划分出三个时代，即1984年至1991年、1991年至1995年以及1995年至2001年，分为三个年龄组：0至18岁、19至61岁以及62至74岁。所有患者至少有1年的随访时间。终点指标为生存率、排斥反应和移植冠状动脉疾病。
共有1012例患者。当前时代供体年龄、移植物缺血时间、老年受者比例以及非标准供体心脏比例均有所增加。1995年后受者的60个月精算生存率分别为：80.7%（0至18岁）；75.3%（19至61岁）；76.2%（>62岁）。与之前的时代相比，当前时代的儿童和年轻成人组结果有所改善（p = 0.003和p = 0.05）。当前时代每人每年等于或大于国际心脏和肺移植学会（ISHLT）3A级的排斥反应发作次数改善至0.15（p < 0.001）。在这三个时代中，老年受者（>62岁）与其他成年人相比排斥反应发作次数较少（0.13对0.58，p = 0.03）。因移植冠状动脉疾病导致的死亡从第2个时代到第3个时代从11%降至5%。回归分析显示供体年龄对生存率和移植冠状动脉疾病有轻微影响（风险比分别为1.02，p = 0.001；风险比为1.039，p < 0.001）。移植冠状动脉疾病的受者预测因素为缺血性心肌病诊断（风险比 = 1.6，p = 0.014）和先天性心脏病（风险比 = 3.41，p = 0.02）。
当前时代生存率的提高可能归因于更好的器官保存、改善的免疫抑制和感染控制以及危及生命的移植冠状动脉疾病减少。
