Primo G, Le Clerc J L, Antoine M, De Smet J M, Joris M
Department of Cardiac Surgery, University Hospital Erasme, Brussels, Belgium.
Acta Cardiol. 1991;46(5):555-65.
Between March 1982 and March 1991, 225 heart transplantations (HTx) have been performed in 220 patients suffering end stage cardiac disease. Thirteen percent were females and 87% were males. Age range was from 5 to 68 years. The underlying cardiac disease was ischemic cardiopathy in 51.5%, congestive dilated cardiomyopathy in 42%, valvular cardiomyopathy in 3.5%, toxic myocarditis (post-adriamycin) in 1.5% and chronic rejection in 2.5% (retransplantation). Selection of the recipients was done following the currently well established criteria also taking into account the absolute major contraindications for HTx. Due to the still increasing demand of donor organs, currently donor age has been extended up to 50 years for male and 55 years for female donors. One quarter of the grafts were harvested on site in our institution, two other quarters were harvested somewhere else in Belgium and the last quarter provided by other countries cooperating with Eurotransplant. All patients have undergone orthotopic cardiac transplantation using the standard Lower and Shumway technique. Immunosuppression protocols have changed four times throughout the years. Nevertheless all were based on the use of Ciclosporine variously combined with other current immunosuppressive drugs. Rejection monitoring relied on routine endocardiac biopsy and was diagnosed according to the Billingham criteria. The in-hospital mortality is currently 11%. Infection, early right heart graft failure and acute rejection were the leading causes of death. The major causes of early morbidity were several curable infections, reversible rejection episodes, transient acute renal failure and controllable arterial hypertension. Among the survivors followed for at least one month up to nine years, half of late mortality was caused by chronic rejection followed by infection, sudden death, metabolic disorders, stroke and malignancy. Late morbidity involves cases of mild coronary graft diseases, biological renal insufficiency, some degree of arterial hypertension, dislipidemia. Current actuarial survival rate is 87% at one year, 76% at 5 years up to 9 years. Our experience confirms that HTx represents today and effective therapy for selected patients suffering end stage cardiac disease.
1982年3月至1991年3月期间，对220例终末期心脏病患者进行了225例心脏移植手术。其中13%为女性，87%为男性。年龄范围为5至68岁。潜在的心脏病中，缺血性心脏病占51.5%，充血性扩张型心肌病占42%，瓣膜性心肌病占3.5%，中毒性心肌炎（阿霉素后）占1.5%，慢性排斥反应（再次移植）占2.5%。接受者的选择遵循目前已确立的标准，并考虑到心脏移植的绝对主要禁忌证。由于对供体器官的需求仍在增加，目前男性供体年龄已延长至50岁，女性供体年龄已延长至55岁。四分之一的移植物在我们机构现场获取，另外四分之二在比利时其他地方获取，最后四分之一由与欧洲移植协会合作的其他国家提供。所有患者均采用标准的Lower和Shumway技术进行原位心脏移植。这些年来，免疫抑制方案已经改变了四次。然而，所有方案均基于环孢素与其他当前免疫抑制药物的不同组合使用。排斥反应监测依靠常规的心内膜活检，并根据Billingham标准进行诊断。目前院内死亡率为11%。感染、早期右心移植失败和急性排斥反应是主要死亡原因。早期发病的主要原因是几种可治愈的感染、可逆性排斥反应发作、短暂性急性肾衰竭和可控性动脉高血压。在随访至少1个月至9年的幸存者中，晚期死亡率的一半由慢性排斥反应引起，其次是感染、猝死、代谢紊乱、中风和恶性肿瘤。晚期发病包括轻度冠状动脉移植疾病、生物性肾功能不全、一定程度的动脉高血压、血脂异常等病例。目前的精算生存率在1年时为87%，在5年至9年时为76%。我们的经验证实，心脏移植目前是治疗选定的终末期心脏病患者的有效疗法。
