Gallo P, Agozzino L, Arbustini E, Baroldi G, Bartoloni G, Bonacina E, Bosman C, Catani G, Cocco P, Di Giola C
Sezione di Patologia, Università La Sapienza, Roma.
G Ital Cardiol. 1992 Jul;22(7):843-53.
All the transplantation units within the Italian Heart Transplantation Project are supported by a section of pathology, devoted to the study of the recipient's heart, to patient monitoring by means of a schedule of endomyocardial biopsies, and, if that was the case, to examine the donor's heart and to analyse the causes of death. When successes and failures of the first five years of the Project's activity are weighed up, good results are observed: of the 847 operations performed (orthotopic, heterotopic and heart-lung transplants, and re-transplants) an actuarial survival rate of 77% at 5 years has been achieved. The sections of pathology believe to have contributed significantly to these results, examining as many as 10,446 endomyocardial biopsies. The indications for transplantation were: dilated cardiomyopathy (48.5%); ischemic (35.3%); valvular (5.9%) and congenital (2.4%) heart disease; hypertrophic cardiomyopathy (2.2%); endocardial fibroelastosis (1.7%); restrictive cardiomyopathy (1.4%); anthracycline cardiotoxicity (0.8%); myocarditis (0.8%); cardiac tumours (0.5%) and arrhythmogenic cardiomyopathy (0.2%). Distribution of recipients by sex and age varied according to the indications for transplantation: males were more common among the patients transplanted for ischemic (97%) and valvular (84%) heart disease, as well as for dilated (82%) and hypertrophic (78%) cardiomyopathy, whereas the opposite was true for endocardial fibroelastosis (males constituting 21%) and cardiac tumours (25%). Mean age at transplantation ranged from 49 years (ischemic heart disease) to 6 years (endocardial fibroelastosis). In the follow-up period, a 17.5% death rate was recorded; the main causes of death were the early failure of the transplanted heart (27 pts), postoperative complications (16), hyperacute rejection (4), acute rejection (18), infections (the singular most frequent cause of death, 35 pts), the proliferative endoarteritis of coronary branches (the so-called chronic rejection, that caused 21 deaths and required 14 re-transplants) and the development of neoplasms (11). The actuarial survival curve drops to 89% after the first postoperative month, abates to 82% at the end of the first year, and progressively decreases to 77% at the end of the fifth follow-up year. Rejection monitoring required an average number of 12.5 endomyocardial biopsies per recipient, and allowed 1.7 rejection episodes per patient to be diagnosed. The fewer were the rejection episodes occurring in a unit, the higher was the percentage of deaths due to infections.(ABSTRACT TRUNCATED AT 400 WORDS)
意大利心脏移植项目中的所有移植单位都有一个病理科提供支持，该病理科致力于研究受者的心脏，通过心内膜活检计划对患者进行监测，如有需要，还会检查供者的心脏并分析死亡原因。在权衡该项目头五年的成败时，可以看到取得了良好的成果：在进行的847例手术（原位、异位和心肺移植以及再次移植）中，5年的精算生存率达到了77%。病理科认为他们对这些结果做出了重大贡献，共检查了多达10446例心内膜活检。移植的适应证包括：扩张型心肌病（48.5%）；缺血性（35.3%）；瓣膜性（5.9%）和先天性（2.4%）心脏病；肥厚型心肌病（2.2%）；心内膜弹力纤维增生症（1.7%）；限制型心肌病（1.4%）；蒽环类药物心脏毒性（0.8%）；心肌炎（0.8%）；心脏肿瘤（0.5%）和致心律失常性心肌病（0.2%）。受者按性别和年龄的分布因移植适应证而异：在因缺血性（97%）和瓣膜性（84%）心脏病以及扩张型（82%）和肥厚型（78%）心肌病接受移植的患者中，男性更为常见，而在心内膜弹力纤维增生症（男性占21%）和心脏肿瘤（25%）患者中则相反。移植时的平均年龄从49岁（缺血性心脏病）到6岁（心内膜弹力纤维增生症）不等。在随访期间，记录的死亡率为17.5%；主要死亡原因是移植心脏早期功能衰竭（27例）、术后并发症（16例）、超急性排斥反应（4例）、急性排斥反应（18例）、感染（是最常见的单一死亡原因，35例）、冠状动脉分支的增殖性动脉内膜炎（即所谓的慢性排斥反应，导致21例死亡并需要14例再次移植）以及肿瘤的发生（11例）。术后第一个月后精算生存曲线降至89%，第一年末降至82%，在第五年随访结束时逐渐降至77%。排斥反应监测每位受者平均需要进行12.5例心内膜活检，并能诊断出每位患者平均1.7次排斥反应发作。一个单位发生的排斥反应发作次数越少，因感染导致的死亡百分比就越高。（摘要截选至400字）
