Chin Clifford, Naftel David, Pahl Elfriede, Shankel Tamara, Clark Mary Lynne, Gamberg Pat, Kirklin James, Webber Steve
Department of Pediatric Cardiology, Stanford University, Palo Alto, California, USA.
J Heart Lung Transplant. 2006 Dec;25(12):1420-4. doi: 10.1016/j.healun.2006.09.020.
Cardiac re-transplantation (re-Tx) among pediatric recipients remains controversial. The purpose of this study is to use the Pediatric Heart Transplant Study (PHTS) database to investigate the incidence of re-Tx and analyze the risk factors and outcomes after transplantation among children.
The PHTS database was reviewed for all subjects <or=18 years of age at the time of primary transplant and re-Tx from January 1, 1993 through December 31, 2004. Multivariate analyses in the hazard-function domain were used to identify risk factors for re-Tx and for mortality after re-Tx.
Risk factors for re-Tx include ventilator support, African-American ethnicity and elevated creatinine. Patient survival was inferior to that after primary transplantation (PTx) with 1-, 3- and 5-year survival probability after re-Tx of 80%, 69% and 60%, respectively (p = 0.04). Patients re-transplanted for graft coronary artery disease fared better than those re-transplanted for early graft failure. A shorter time period between PTx and re-Tx was a significant risk factor for survival according to univariate analysis. However, risk factors for death after re-Tx by multivariate analysis included only early graft failure and rejection during PTx.
Survival after pediatric re-Tx is inferior to that after PTx. Re-transplantation for graft failure and rejection are associated with high relative risks for death. Given the limitations of donor availability, re-Tx for early graft failure and rejection appear contraindicated but appears acceptable for those who have survived >or=1 year after their PTx, especially those with graft coronary artery disease.
小儿心脏移植受者再次移植仍存在争议。本研究旨在利用小儿心脏移植研究（PHTS）数据库调查再次移植的发生率，并分析儿童移植后的危险因素及结局。
回顾1993年1月1日至2004年12月31日期间初次移植和再次移植时年龄≤18岁的所有PHTS数据库受试者。在风险函数领域进行多变量分析，以确定再次移植的危险因素以及再次移植后的死亡危险因素。
再次移植的危险因素包括呼吸机支持、非裔美国人种族和肌酐升高。患者生存率低于初次移植后，再次移植后1年、3年和5年生存率分别为80%、69%和60%（p = 0.04）。因移植冠状动脉疾病而再次移植的患者比因早期移植失败而再次移植的患者预后更好。根据单变量分析，初次移植与再次移植之间较短的时间是生存的重要危险因素。然而，多变量分析显示再次移植后死亡的危险因素仅包括早期移植失败和初次移植期间的排斥反应。
小儿再次移植后的生存率低于初次移植。因移植失败和排斥反应而再次移植与较高的死亡相对风险相关。鉴于供体可用性的限制，因早期移植失败和排斥反应而进行的再次移植似乎是禁忌的，但对于初次移植后存活≥1年的患者，尤其是患有移植冠状动脉疾病的患者，再次移植似乎是可以接受的。
