De La Zerda David J, Cohen Oved, Beygui Ramin E, Kobashigawa John, Hekmat Diana, Laks Hillel
Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1741, USA.
Transplantation. 2007 May 15;83(9):1214-8. doi: 10.1097/01.tp.0000261713.24244.ea.
The outcome of heart transplantation is highly influenced by good donor selection. Because a history of alcoholism is prevalent among potential heart donors, we sought to explore the effect of alcohol use in donors on the outcome of heart transplantation in the recipient.
A total of 437 consecutive patients underwent heart transplantation from January 2002 through September 2005. Patients' files were retrospectively studied. Mean follow-up period was 3.14+/-1.9 years (range, 3 days to 6.5 yrs). The cohort was divided into two subgroups. The alcoholic donor group (ADG) included 98 of 421 patients and the nonalcoholic donor group (NADG) included 323 of 421 patients. Mean age was 35.3+/-11.4 yrs (range, 18-66) for the ADG and 33+/-12.2 yrs (range, 18-62) for the NADG.
Mortality among the ADG was 7 of 98 (7.1%) and for NADG was 55 of 323 (17.1%) (P=0.015). The mean interval time between transplant and mortality was, for ADG, 27.7+/-20.6 months (range, 0.07-51) and for NADG, 16.4+/-19.6 months (range, 0.14-73) (P=0.031). Survival rate was significantly higher among the ADG at 72.8+/-1.9 months compared with NADG at 66.2+/-1.5 months (P=0.019). Overall rejection rate was 22 of 421 (5.2%); rejection rate was 17 of 323 (5.2%) in NADG and 5 of 98 (5.1%) in ADG. Rejection free survival was 74.6+/-0.85 with no significant difference between the two groups (P=0.85).
The chronic alcoholism of donors was found to be a protective factor regarding the outcome after heart transplantation. Significant differences were found in mortality rate and survival after heart transplantation between the ADG and NADG. These data support the fact that it is safe to use donors' hearts regardless of a history of alcoholism.
心脏移植的结果受良好供体选择的高度影响。由于酗酒史在潜在心脏供体中很常见,我们试图探讨供体饮酒对受体心脏移植结果的影响。
2002年1月至2005年9月,共有437例连续患者接受了心脏移植。对患者档案进行回顾性研究。平均随访期为3.14±1.9年(范围为3天至6.5年)。该队列分为两个亚组。酒精性供体组(ADG)包括421例患者中的98例,非酒精性供体组(NADG)包括421例患者中的323例。ADG的平均年龄为35.3±11.4岁(范围为18 - 66岁),NADG的平均年龄为33±12.2岁(范围为18 - 62岁)。
ADG中的死亡率为98例中的7例(7.1%),NADG中的死亡率为323例中的55例(17.1%)(P = 0.015)。ADG移植与死亡之间的平均间隔时间为27.7±20.6个月(范围为0.07 - 51个月),NADG为16.4±19.6个月(范围为0.14 - 73个月)(P = 0.031)。ADG在72.8±1.9个月时的生存率显著高于NADG在66.2±1.5个月时的生存率(P = 0.019)。总体排斥率为421例中的22例(5.2%);NADG中的排斥率为323例中的17例(5.2%),ADG中的排斥率为98例中的5例(5.1%)。无排斥生存期为74.6±0.85,两组之间无显著差异(P = 0.85)。
发现供体的慢性酒精中毒是心脏移植后结果的一个保护因素。ADG和NADG在心脏移植后的死亡率和生存率方面存在显著差异。这些数据支持了无论供体有无酗酒史使用其心脏都是安全的这一事实。