心脏移植中供体血清钠水平的争议——一项多中心经验

The controversy of donor serum sodium levels in heart transplantation--a multicenter experience.

作者信息

Kaczmarek I, Tenderich G, Groetzner J, Deutsch M-A, Schulz U, Beiras-Fernandez A, Meiser B, Wahlers T, Koerfer R, Reichart B

机构信息

Department of Cardiac Surgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Münich, Germany.

出版信息

Thorac Cardiovasc Surg. 2006 Aug;54(5):313-6. doi: 10.1055/s-2006-923889.

DOI:10.1055/s-2006-923889

PMID:16902878

Abstract

BACKGROUND

Elevated donor serum sodium is a phenomenon often encountered in the management of brain dead donors. The clinical relevance on recipient outcome is less examined. We investigated the impact of elevated donor serum sodium levels (DSL) on outcome after heart transplantation in 1800 heart transplantations.

METHODS

Data was conducted in a retrospective analysis from 1989 until 2005. The transplantations were performed at three German heart transplant centers. The joined database included DSL at the time of organ procurement, recipient and donor age, ischemia time, primary graft failure and survival data.

RESULTS

Mean DSL was 147.7 +/- 10.3 l/l (range 111 - 208 l/l). Recipients were divided into 4 groups with percentiles of 141, 147, and 154 l/l resulting in DSL of A: 135.8 +/- 4.4, B: 143.6 +/- 1.7, C: 149.7 +/- 1.9, and D: 161.3 +/- 7.7 l/l for the four quartiles. Primary graft failure occurred in 2.6 % of the patients with A: 2.8 %, B: 2.8 %, C: 3.7% and D: 1.4 % ( P = n.s.). Mean 5- and 10-year-survival rates were 70.9 % (57.6 %) with A: 71.1 % (53.86 %), B: 69.3 % (53.9 %), C: 72.7 % (61.0 %), D: 71.2 % (62.4 %), respectively ( P = n. s.). In a multivariate analysis a significant impact on postoperative results could be revealed for recipient age ( P = 0.002), ischemia time ( P = 0.002) and donor age ( P = 0.009). DSL were no individual risk factor in the multivariate analysis.

CONCLUSION

There was no impact of donor serum sodium levels neither on early postoperative results, nor on long-term outcome indicating that cardiac allografts from donors with elevated sodium levels might be transplanted successfully, achieving favourable results.

摘要

背景

供体血清钠升高是脑死亡供体管理中经常遇到的现象。关于其对受体预后的临床相关性研究较少。我们在1800例心脏移植中调查了供体血清钠水平（DSL）升高对心脏移植术后预后的影响。

方法

对1989年至2005年的数据进行回顾性分析。这些移植手术在三个德国心脏移植中心进行。联合数据库包括器官获取时的DSL、受体和供体年龄、缺血时间、原发性移植失败和生存数据。

结果

平均DSL为147.7±10.3 mmol/l（范围111 - 208 mmol/l）。受体被分为4组，四分位数分别为141、147和154 mmol/l，四组的DSL分别为：A组135.8±4.4 mmol/l，B组143.6±1.7 mmol/l，C组149.7±1.9 mmol/l，D组161.3±7.7 mmol/l。原发性移植失败发生率在各患者组中为2.6%，其中A组为2.8%，B组为2.8%，C组为3.7%，D组为1.4%（P=无显著差异）。平均5年和10年生存率分别为70.9%（57.6%），其中A组为71.1%（53.86%），B组为69.3%（53.9%），C组为72.7%（61.0%），D组为71.2%（62.4%）（P=无显著差异）。在多变量分析中，可发现受体年龄（P = 0.002）、缺血时间（P = 0.002）和供体年龄（P = 0.009）对术后结果有显著影响。在多变量分析中，DSL不是个体危险因素。