Radovancevic Branislav, Konuralp Cuneyt, Vrtovec Bojan, Radovancevic Rajko, Thomas Cynthia D, Zaqqa Munir, Vaughn William K, Frazier O H
Department of Cardiopulmonary Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77225, USA.
J Heart Lung Transplant. 2005 Feb;24(2):156-9. doi: 10.1016/j.healun.2003.11.399.
We sought to identify factors predictive of long-term (>10-year) survival in heart transplant (HTx) recipients.
Four hundred fifteen adult patients underwent HTx at our institution between August 1982 and May 1997. The 158 patients who survived >10 years (Group A) and the 116 patients who died between 2 and 6 years (Group B) of HTx were compared in terms of gender, gender mismatch, ethnicity, age, height, weight, United Network for Organ Sharing status, type of induction therapy (OKT3 or anti-thymocyte globulin), infections (bacterial, viral, fungal and protozoal), cytomegalovirus (CMV) status, CMV mismatch, diabetes mellitus, hypertension and incidence of rejection episodes and transplant coronary artery disease within 2 years of HTx.
Group A (135 men, 23 women; mean age 48 +/- 11 years) had significantly fewer post-HTx rejection episodes and viral, bacterial, fungal and total infections than did Group B (95 men, 21 women; mean age 49 +/- 12 years). Group A also had a significantly lower mean donor age, a lower incidence of pre-HTx diabetes, and a lower mean cholesterol level 1 year after HTx. In a multivariate analysis, fewer bacterial infections and rejection episodes after HTx, the absence of pre-HTx diabetes, and lower donor age were associated with longer survival.
Pre-HTx diabetes, donor age and incidences of infection and rejection within 2 years of HTx predict long-term (>10-year) survival. Better control of infection and rejection during the first 2 years after HTx may improve survival.
我们试图确定心脏移植（HTx）受者长期（>10年）生存的预测因素。
1982年8月至1997年5月期间，415例成年患者在我们机构接受了心脏移植。比较了158例存活超过10年的患者（A组）和116例在心脏移植后2至6年死亡的患者（B组）在性别、性别不匹配、种族、年龄、身高、体重、器官共享联合网络状态、诱导治疗类型（OKT3或抗胸腺细胞球蛋白）、感染（细菌、病毒、真菌和原生动物）、巨细胞病毒（CMV）状态、CMV不匹配、糖尿病、高血压以及心脏移植后2年内排斥反应发作和移植冠状动脉疾病的发生率。
A组（135名男性，23名女性；平均年龄48±11岁）心脏移植后的排斥反应发作以及病毒、细菌、真菌和总感染次数明显少于B组（95名男性，21名女性；平均年龄49±12岁）。A组的供体平均年龄也显著较低，心脏移植前糖尿病的发生率较低，心脏移植后1年的平均胆固醇水平也较低。在多变量分析中，心脏移植后较少的细菌感染和排斥反应发作、心脏移植前无糖尿病以及较低的供体年龄与更长的生存期相关。
心脏移植前糖尿病、供体年龄以及心脏移植后2年内的感染和排斥反应发生率可预测长期（>10年）生存。在心脏移植后的前2年更好地控制感染和排斥反应可能会改善生存情况。
