Jimenez Javier, Bennett Edwards Leah, Higgins Robert, Bauerlein Joseph, Pham Si, Mallon Stephen
University of Miami-School of Medicine, Jackson Memorial Medical Center, Miami, FL 33136, USA.
J Heart Lung Transplant. 2005 Feb;24(2):178-83. doi: 10.1016/j.healun.2003.10.019.
Improved outcomes with contemporary medical therapy in patients with advanced heart failure brings into question the survival advantage of transplantation for patients in stable United Network for Organ Sharing (UNOS) Status 2.
Between January 1999 and June 2001, a total of 7,539 adult patients were listed for heart transplantation. Of those, 4,255 (56.4%) patients were listed as UNOS Status 2. Using a competing risk method, we computed probabilities of events while on the waiting list. Additionally, we used a time-dependent proportional hazards model to determine predictors of death before and after transplantation.
Demographics included age >60 (72%), female sex (23%), ischemic causes for transplantation (49%), white race (85%), and median time on the waiting list (544 days). Laboratory and hemodynamic values included mean serum albumin of 3.9 g/dl, serum creatinine of 1.4 mg/dl, mean pulmonary artery pressure of 28 mm Hg, mean pulmonary capillary wedge pressure of 19 mm Hg, and mean cardiac output of 4.5 liter/min. Final outcomes on the waiting list for patients initially listed as UNOS Status 2 were transplantation (48%), removal from the list (11.5%), death (11.4%), and continued listing (29%). At 30 months after transplantation, survival was 81% for patients undergoing transplantation as Status 1A, 77% as Status 1B, and 83% as Status 2, and showed no difference among groups. At 365 days, survival analysis showed no difference for patients listed and undergoing transplantation as UNOS Status 2 compared with those still waiting as Status 2.
In the current era of advances in medical and surgical therapies for heart failure, we found no survival benefit of cardiac transplantation at 1 year for patients initially listed as UNOS Status 2.
当代医学疗法使晚期心力衰竭患者的预后得到改善，这让人质疑对于处于器官共享联合网络（UNOS）2级稳定状态的患者而言，心脏移植在生存方面的优势。
在1999年1月至2001年6月期间，共有7539名成年患者被列入心脏移植名单。其中，4255名（56.4%）患者被列为UNOS 2级。我们采用竞争风险法计算了等待名单上患者发生各类事件的概率。此外，我们使用时间依赖性比例风险模型来确定移植前后死亡的预测因素。
人口统计学特征包括年龄>60岁（72%）、女性（23%）、因缺血性病因进行移植（49%）、白种人（85%）以及在等待名单上的中位时间（544天）。实验室和血流动力学值包括平均血清白蛋白3.9 g/dl、血清肌酐1.4 mg/dl、平均肺动脉压28 mmHg、平均肺毛细血管楔压19 mmHg以及平均心输出量4.5升/分钟。最初被列为UNOS 2级的患者在等待名单上的最终结局为移植（48%）、从名单上移除（11.5%）、死亡（11.4%）以及继续留在名单上（29%）。移植后30个月时，1A状态患者移植后的生存率为81%，1B状态患者为77%，2级状态患者为83%，各组之间无差异。在365天时，生存分析显示，与仍作为2级状态等待的患者相比，被列为UNOS 2级并接受移植的患者无差异。
在当前心力衰竭内外科治疗取得进展的时代，我们发现最初被列为UNOS 2级的患者在1年时进行心脏移植并无生存获益。
