Zaroff Jonathan G, Babcock Wayne D, Shiboski Stephen C
Department of Medicine, University of California, San Francisco California 94143-0124, USA.
J Heart Lung Transplant. 2003 Mar;22(3):334-7. doi: 10.1016/s1053-2498(02)00554-5.
Because of the shortage of heart donors in the United States, efforts are necessary to maximize the yield of donor screening. The purpose of this study was to quantify the effects of left ventricular (LV) systolic dysfunction on heart donor use.
Using the California Transplant Donor Network database, the records of all potential organ donors screened between January 1997 and June 1998 were reviewed. After excluding subjects for whom family consent could not be obtained and subjects <13 or >or=60 years old, a study group of 223 potential heart donors was analyzed. The number of hearts not used because of LV dysfunction, coronary artery disease (CAD), valvular disease, and LV hypertrophy were quantified. A logistic regression model was developed to quantify the independent effect of LV dysfunction on donor use rates after adjustment for age, weight, and cause of death.
Ninety-nine (44%) of the 223 potential donor hearts were not transplanted. Thirty-six of these hearts were not transplanted because of cardiac causes, primarily LV dysfunction (26 cases) and CAD (8 cases). The multivariable analysis showed that after adjusting for other donor variables, ejection fraction was the most significant predictor of non-use, with an odds ratio of 1.48 per 5-point decrease in ejection fraction.
Left ventricular dysfunction is an important cause of failure to transplant adult donor hearts. Efforts to improve the yield of heart donor screening should focus on prevention or reversal of LV dysfunction.
由于美国心脏供体短缺，必须努力使供体筛查的收益最大化。本研究的目的是量化左心室（LV）收缩功能障碍对心脏供体利用的影响。
利用加利福尼亚移植供体网络数据库，回顾了1997年1月至1998年6月期间所有接受筛查的潜在器官供体的记录。在排除无法获得家属同意的受试者以及年龄小于13岁或大于等于60岁的受试者后，对223名潜在心脏供体的研究组进行了分析。量化了因左心室功能障碍、冠状动脉疾病（CAD）、瓣膜疾病和左心室肥厚而未使用的心脏数量。建立了一个逻辑回归模型，以量化在调整年龄、体重和死亡原因后左心室功能障碍对供体利用率的独立影响。
223颗潜在供体心脏中有99颗（44%）未被移植。其中36颗心脏因心脏原因未被移植，主要是左心室功能障碍（26例）和CAD（8例）。多变量分析显示，在调整其他供体变量后，射血分数是未使用的最显著预测因素，射血分数每降低5分，比值比为1.48。
左心室功能障碍是成年供体心脏移植失败的重要原因。提高心脏供体筛查收益的努力应集中在预防或逆转左心室功能障碍上。
