小儿心脏移植的长期结果。

Long-term results of pediatric heart transplantation.

作者信息

Minami Kazutomo, von Knyphausen Edzard, Niino Tetsuya, Blanz Ute, Tenderich Gero, Wlost Stefan, Meyer Hans, Körfer Reiner

机构信息

Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhein-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany.

出版信息

Ann Thorac Cardiovasc Surg. 2005 Dec;11(6):386-90.

PMID:16401987

Abstract

OBJECTIVE

We retrospectively reviewed 104 consecutive patients who underwent orthotopic heart transplantation between November 1989 and February 2004.

PATIENTS AND METHODS

From November 1989 to February 2004, the total number of heart transplantations were 1,340 cases at our institute. One hundred four (7.8%) of these 1,340 patients were pediatrics. Average age was 6.2 years, ranging from 4 months to 16 years. The cause of heart disease before transplantation was: idiopathic dilated cardiomyopathy (DCM) in 74 patients (71%), and congenital heart disease (CHD) in 30 (29%).

RESULTS

Hospital mortality rate was 14.4% (15 patients). Late complications were rejection in 23 (22.1%), infection in 11 (10.6%), gingival hyperplasia in 28 (26.9%), hypertention in 22 (21.1%), coronary artery disease (CAD) in 12 (12.5%), graft failure in 11(10.5%), and malignancy in 2 (1.9%). Late mortality occurred in 11 (10.6%) patients. Causes of death were sudden death in 2 (1.9%), CAD in 3 (2.8%), graft failure in 1 (1.0%), acute rejection in 4 (4.6%), and infection in 1 (1.0%). Actuarial survival rates in pediatrics at 1, 5, 10 years were 82%, 80%, and 78%, respectively. On the other hand, actuarial survival rates in adults at 1, 5, 10 years were 78%, 75%, 59%, respectively.

CONCLUSION

Heart transplantation for pediatrics is an effective therapy with acceptable morbidity and mortality. The long-term survival results in pediatrics are comparable to those of adult heart transplantations. However, the actuarial survival rate in pediatrics after 10 years is significantly better than in adults' cases. Renal function in pediatric heart transplantation recipients treated with cyclosporine remains stable during long-term follow-up.

摘要

目的

我们回顾性分析了1989年11月至2004年2月期间连续接受原位心脏移植的104例患者。

患者与方法

1989年11月至2004年2月，我院共进行心脏移植1340例。其中104例（7.8%）为儿科患者。平均年龄6.2岁，范围从4个月至16岁。移植前心脏病病因如下：74例（71%）为特发性扩张型心肌病（DCM），30例（29%）为先天性心脏病（CHD）。

结果

医院死亡率为14.4%（15例患者）。晚期并发症包括：23例（22.1%）发生排斥反应，11例（10.6%）发生感染，28例（26.9%）发生牙龈增生，22例（21.1%）发生高血压，12例（12.5%）发生冠状动脉疾病（CAD），11例（10.5%）发生移植物功能衰竭以及2例（1.9%）发生恶性肿瘤。11例（10.6%）患者发生晚期死亡。死亡原因分别为：2例（1.9%）猝死，3例（2.8%）CAD，1例（1.0%）移植物功能衰竭，4例（4.6%）急性排斥反应以及1例（1.0%）感染。儿科患者1年、5年、10年的精算生存率分别为82%、80%和78%。另一方面，成人患者1年、5年、10年的精算生存率分别为78%、75%、59%。