Felker G Michael, Hernandez Adrian F, Rogers Joseph G, Russell Stuart D, Reinsmoen Nancy L, Rosenberg Paul, Hata Jonathan A, Lodge Andrew J, Milano Carmelo A
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Clin Transpl. 2004:235-41.
Since beginning cardiac transplantation in 1985, Duke University Medical Center has performed 485 de novo heart transplants in adult recipients. Our program has broadened the access of patients to transplantation through the aggressive use of ventricular assist devices as bridge to transplant in patients with acute heart failure and shock, as well as through the introduction of an alternate list program for suboptimal transplant candidates. Despite this broadening of the recipient pool, our long-term outcomes have remained good, with 5-year survival of 75% and 10-year survival of 51%. Continued advances in immunosuppression and treatment for cardiac allograft vasculopathy seem likely to continue to improve long-term outcomes from cardiac transplantation. Expanding indications for VAD support (such as destination therapy) and continued improvements in this technology seem certain to impact patient selection and therefore the results of transplantation in the future. Appropriate triage of patients with advanced heart failure among available therapies will be the cornerstone of optimizing outcomes in this critically ill patient population.
自1985年开展心脏移植以来，杜克大学医学中心已为成年受者进行了485例初次心脏移植手术。我们的项目通过积极使用心室辅助装置作为急性心力衰竭和休克患者移植的桥梁，以及通过为不太适合移植的候选人引入候补名单项目，扩大了患者接受移植的机会。尽管受者群体有所扩大，但我们的长期结果仍然良好，5年生存率为75%，10年生存率为51%。免疫抑制和心脏移植血管病变治疗方面的持续进展似乎可能继续改善心脏移植的长期结果。心室辅助装置支持的适应证不断扩大（如终末期治疗）以及该技术的持续改进似乎肯定会影响患者选择，从而影响未来的移植结果。在现有治疗方法中对晚期心力衰竭患者进行适当的分诊将是优化这一危重症患者群体治疗结果的基石。
