Logeais Yves, Lelong Bernard, Langanay Thierry, Corbineau Hervé, Rioux Claude, Leguerrier Alain
Service de Chirurgie Thoracique et Cardiovasculaire, Centre Cardio-Pneumologique, Hôpital Pontchaillou-CHU-35043 Rennes.
Bull Acad Natl Med. 2003;187(2):325-40; discussion 340-3.
Heart failure is one of the leading causes of hospitalization and death. The aim of this study was to evaluate long term outcomes after cardiac transplantation.
A retrospective review of 222 consecutive cardiac allograft recipients who underwent 233 transplantations between 1986 to 2000 was undertaken. Cardiomyopathy (123) and ischemic heart disease (87) were the most common indications. Mean age was 51 years +/- 11, and male gender was predominant (184).
33 patients (14.8%) died in the post operative period, mainly from graft failure (24 pts). During the follow-up period (total 1157 pt/yrs, mean 6.2 +/- 5 yrs, max 16 yrs), 60 late deaths occurred from cancer (21), graft failure (13), infection (13), and miscellaneous (13). Retransplantations were performed in 11 patients. The actuarial survival of the entire cohort was 75%, 66% and 50% at 1, 5, and 10 years respectively.
Cardiac transplantation gives satisfactory long term results for patients with end-stage heart failure, providing good exercise tolerance and survival for 10 years or more in a large number of patients. Improvement in immunosuppression therapy is responsible for decrease in acute rejection rate. Reduction in HLA mismatch should allow for better immunomodulation and decreased incidence of cardiac allograft vasculopathy and malignancies.
心力衰竭是住院和死亡的主要原因之一。本研究的目的是评估心脏移植后的长期结果。
对1986年至2000年间连续接受233次移植的222例心脏移植受者进行回顾性研究。心肌病（123例）和缺血性心脏病（87例）是最常见的适应症。平均年龄为51岁±11岁，男性占主导（184例）。
33例患者（14.8%）在术后死亡，主要死于移植失败（24例）。在随访期间（总计1157患者年，平均6.2±5年，最长16年），60例晚期死亡由癌症（21例）、移植失败（13例）、感染（13例）和其他原因（13例）导致。11例患者进行了再次移植。整个队列的1年、5年和10年精算生存率分别为75%、66%和50%。
心脏移植为终末期心力衰竭患者提供了令人满意的长期结果，使大量患者具有良好的运动耐量并存活10年或更长时间。免疫抑制治疗的改善导致急性排斥反应率降低。HLA配型不匹配的减少应有助于更好的免疫调节，并降低心脏移植血管病变和恶性肿瘤的发生率。
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