Razzouk Anees J, Johnston Joyce K, Larsen Ranae L, Chinnock Richard E, Fitts James A, Bailey Leonard L
Division of Cardiothoracic Surgery, Departments of Surgery and Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA.
J Heart Lung Transplant. 2005 Feb;24(2):195-9. doi: 10.1016/j.healun.2003.11.398.
There are few published data regarding the long-term outcome of "large" cardiac allografts in children. This study examines the effect of cardiac graft oversizing on the survival of pediatric patients with congenital heart disease (CHD).
Two hundred ninety-one children, age 1 day to 17 years (median 50 days), with CHD underwent primary cardiac transplantation between 1985 and 2002. Patients were analyzed according to donor-recipient weight ratio (D-R): Group (Gp) I (n = 252) with D-R <2.5 (range 0.59 to 2.49, median 1.4), and Gp II (n = 39) with D-R >/=2.5 (range 2.5 to 4.65, median 2.78). CHD diagnoses included hypoplastic left heart syndrome (138 in Gp I, 13 in Gp II), single ventricle (29 in Gp I, 1 in Gp II) and other (85 in Gp I, 13 in Gp II). Patients with cardiomyopathy were excluded. Pre-transplant cardiac palliation was performed in 36% of Gp I and 15% of Gp II patients. The average graft ischemic times (minutes) were 266 +/- 7.5 and 283 +/- 18.9 for Gp I and Gp II, respectively (p < 0.2).
The operative mortality for Gp I was 10.3% and 10.2% for Gp II (p < 0.99). There was no significant difference between the 2 groups in length of hospital stay (p < 0.15) or duration of ventilator support (p < 0.6) post-transplantation. However, the incidence of open chest was higher (p < 0.003) in Gp II (28%) compared with Gp I (8%). The survival rates for Gp I and Gp II were: 82 +/- 2.4% vs 84 +/- 5.7% at 1 year; 71 +/- 2.9% vs 72 +/- 7.2% at 5 years; and 63 +/- 3.2% vs 65% +/- 7.4 at 10 years.
Post-transplant morbidity and short- and long-term survival of pediatric recipients with CHD are not adversely influenced by the use of oversized cardiac allografts.
关于儿童“大型”心脏移植长期结果的已发表数据很少。本研究探讨心脏移植供体过大对先天性心脏病（CHD）小儿患者生存的影响。
1985年至2002年间，291例年龄1天至17岁（中位年龄50天）的CHD患儿接受了原位心脏移植。根据供受体体重比（D-R）对患者进行分析：I组（n = 252），D-R <2.5（范围0.59至2.49，中位值1.4）；II组（n = 39），D-R≥2.5（范围2.5至4.65，中位值2.78）。CHD诊断包括左心发育不全综合征（I组138例，II组13例）、单心室（I组29例，II组1例）及其他（I组85例，II组13例）。排除心肌病患者。I组36%和II组15%的患者在移植前进行了心脏姑息治疗。I组和II组的平均移植物缺血时间（分钟）分别为266±7.5和283±18.9（p < 0.2）。
I组的手术死亡率为10.3%，II组为10.2%（p < 0.99）。两组移植后的住院时间（p < 0.15）或呼吸机支持时间（p < 0.6）无显著差异。然而，II组（28%）开胸发生率高于I组（8%）（p < 0.003）。I组和II组的生存率分别为：1年时82±2.4%对84±5.7%；5年时71±2.9%对72±7.2%；10年时63±3.2%对65%±7.4%。
使用过大的心脏移植物对CHD小儿受者移植后的发病率及短期和长期生存无不利影响。
