Cohen O, De La Zerda D J, Beygui R, Hekmat D, Laks H
Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1741, USA.
Transplant Proc. 2007 Dec;39(10):2964-9. doi: 10.1016/j.transproceed.2007.08.102.
We sought to explore whether the cause of donor brain death influenced recipient outcomes after cardiac transplantation. In retrospect, 358 consecutive donors provided cardiac allografts to adult patients undergoing orthotopic heart transplantation at a single urban US medical center from January 2000 through December 2005. Alternate recipients were excluded. Mechanism and cause of donor brain injury and death were divided into five categories: anoxia (nontraumatic) (n=36), blunt head trauma (n=220), penetrating head trauma (n=83), brain tumor/infection (n=7), and cerebrovascular event (n=12). The five subgroups were categorized as traumatic or nontraumatic. The end points of the study were causes of early and late mortality, survival, and rejection rate. There were 59 deaths in the 6-year period. Total and short-term recipient mortality were found to be statistically higher among heart transplant recipients when the donors suffered from traumatic brain death compared to those whose brain death etiology was nontraumatic (P=.045, P=.033, respectively). Rejection rate was similar in all groups (P=.497). In conclusion, donor traumatic brain death was found to be a valid risk factor for recipient mortality after heart transplantation. Caution should be used when evaluating such donors, particularly in the presence of other risk factors.
我们试图探究供体脑死亡的原因是否会影响心脏移植术后受体的预后。回顾性分析显示，2000年1月至2005年12月期间，在美国一家城市医疗中心，共有358例连续供体为接受原位心脏移植的成年患者提供了心脏同种异体移植物。排除候补受体。供体脑损伤和死亡的机制及原因分为五类：缺氧（非创伤性）（n = 36）、钝性头部外伤（n = 220）、穿透性头部外伤（n = 83）、脑肿瘤/感染（n = 7）和脑血管事件（n = 12）。这五个亚组被归类为创伤性或非创伤性。该研究的终点为早期和晚期死亡原因、生存率及排斥反应发生率。在这6年期间共有59例死亡。与脑死亡病因是非创伤性的供体相比，心脏移植受体中，供体为创伤性脑死亡时，总体及短期受体死亡率在统计学上更高（分别为P = 0.045，P = 0.033）。所有组的排斥反应发生率相似（P = 0.497）。总之，供体创伤性脑死亡被发现是心脏移植术后受体死亡的一个有效危险因素。在评估此类供体时应谨慎，尤其是存在其他危险因素时。
