Kobashigawa Jon A, Starling Randall C, Mehra Mandeep R, Kormos Robert L, Bhat Geetha, Barr Mark L, Sigouin Chris S, Kolesar June, Fitzsimmons William
University of California at Los Angeles, Los Angeles, California 90095, USA.
J Heart Lung Transplant. 2006 Sep;25(9):1063-9. doi: 10.1016/j.healun.2006.05.001. Epub 2006 Jul 18.
Previous risk factor studies in cardiac transplant patients have analyzed pre-transplant risk factors as they relate to outcomes. This study is the first in-depth multicenter assessment of ongoing post-transplant risk factors in heart transplant patients and their impact on 5-year outcomes.
We reviewed 280 heart transplant patients who survived > 1 year for the impact of post-transplant risk factors (hyperlipidemia, hypertension, diabetes, body mass index [BMI] and renal dysfunction: 8 to 18 possible measurements over 5 years) on outcomes, including death, cardiac allograft vasculopathy (CAV) and non-fatal major adverse cardiac events (NF-MACE).
Upon multivariate Cox regression analysis, significant findings were high total-cholesterol for NF-MACE (relative risk [RR] = 4.34, confidence interval [CI] 1.35 to 13.98, p = 0.01), presence of diabetes for NF-MACE (RR = 3.96, CI 1.24 to 12.65, p = 0.02) and high serum creatinine for graft death (RR = 1.59, CI 1.35 to 1.87, p < 0.001). No covariates were found to be significant for CAV. Other significant risk factors by univariate Cox regression models with time-dependent covariates included BMI > or = 33 for graft death.
Post-transplant risk factors of hypercholesterolemia and diabetes are associated with NF-MACE, whereas high serum creatinine and BMI > or = 33 are associated with graft death. Risk factor modification, including direct therapy to minimize risk factors, should be considered.
先前针对心脏移植患者的危险因素研究分析了移植前危险因素与预后的关系。本研究是首次对心脏移植患者移植后持续存在的危险因素及其对5年预后的影响进行深入的多中心评估。
我们回顾了280例存活超过1年的心脏移植患者，以评估移植后危险因素（高脂血症、高血压、糖尿病、体重指数[BMI]和肾功能不全：5年内8至18项可能的测量指标）对包括死亡、心脏移植血管病变（CAV）和非致命性主要不良心脏事件（NF-MACE）在内的预后的影响。
经多变量Cox回归分析，显著发现包括：总胆固醇水平高与NF-MACE相关（相对风险[RR]=4.34，置信区间[CI]1.35至13.98，p=0.01），糖尿病与NF-MACE相关（RR=3.96，CI 1.24至12.65，p=0.02），血清肌酐水平高与移植物死亡相关（RR=1.59，CI 1.35至1.87，p<0.001）。未发现有协变量对CAV有显著影响。单变量Cox回归模型结合时间依赖性协变量分析发现的其他显著危险因素包括BMI≥33与移植物死亡相关。
移植后高胆固醇血症和糖尿病等危险因素与NF-MACE相关，而血清肌酐水平高和BMI≥33与移植物死亡相关。应考虑对危险因素进行调整，包括采取直接治疗措施以尽量降低危险因素。
