Davies Ryan R, Russo Mark J, Mital Seema, Martens Timothy M, Sorabella Robert S, Hong Kimberly N, Gelijns Annetine C, Moskowitz Alan J, Quaegebeur Jan M, Mosca Ralph S, Chen Jonathan M
Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of New York-Presbyterian and Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
J Thorac Cardiovasc Surg. 2008 Jan;135(1):147-55, 155.e1-2. doi: 10.1016/j.jtcvs.2007.09.019. Epub 2007 Nov 26.
Studies of high-risk pediatric cardiac transplant recipients are lacking. The purpose of this study is to evaluate early posttransplant survival in high-risk pediatric patients.
The United Network for Organ Sharing (UNOS) provided de-identified patient-level data. The study population included 3502 recipients aged less than 21 years who underwent transplantation from January 1, 1995, through December 31, 2005. Recipients were stratified on the basis of the presence or absence of high-risk criteria: pulmonary vascular resistance index greater than 6 Wood units/m2 (n = 285, 8.1%), creatinine clearance less than 40 mL/min (308, 8.8%), hepatitis C positivity (33, 0.9%), donor/recipient weight ratio less than 0.7 (80, 2.3%), panel reactive antibody greater than 40% (235, 6.7%), retransplantation (235, 6.7%), and age less than 1 year old (840, 24.0%).
Overall, 1575 (45.0%) patients met at least one high-risk criterion. Higher numbers of high-risk criteria in a patient were correlated with increased 30-day mortality (0 high-risk criteria: 5.2%; 1 criterion: 7.9%; 2 criteria: 12.9%; and 3 or more criteria: 25.0%; P < .0001) and poor long-term survival (P < .0001). Among patients with high-risk criteria, a simplified scoring scale accurately predicts both 30-day and contingent 1-year mortality (P < .0001).
Individually, the effect of high-risk criteria on posttransplant survival varied; however, increasing numbers of criteria in a patient resulted in a cumulative increase in mortality. A scoring scale allows for the prediction of approximate mortality rates after transplantation. These findings suggest that recipient criteria for transplantation should focus on the number of high-risk criteria as well as clinical status, rather than the presence or absence of a single risk factor.
缺乏对高危小儿心脏移植受者的研究。本研究的目的是评估高危小儿患者移植后的早期生存率。
器官共享联合网络（UNOS）提供了去识别化的患者层面数据。研究人群包括1995年1月1日至2005年12月31日期间接受移植的3502名年龄小于21岁的受者。根据是否存在高危标准对受者进行分层：肺血管阻力指数大于6伍德单位/平方米（n = 285，8.1%）、肌酐清除率小于40毫升/分钟（308，8.8%）、丙型肝炎阳性（33，0.9%）、供体/受体体重比小于0.7（80，2.3%）、群体反应性抗体大于40%（235，6.7%）、再次移植（235，6.7%）以及年龄小于1岁（840，24.0%）。
总体而言，1575名（45.0%）患者至少符合一项高危标准。患者中高危标准数量越多，30天死亡率越高（0项高危标准：5.2%；1项标准：7.9%；2项标准：12.9%；3项或更多标准：25.0%；P <.0001），长期生存率越低（P <.0001）。在有高危标准的患者中，一个简化的评分量表能准确预测30天和1年的意外死亡率（P <.0001）。
单独来看，高危标准对移植后生存的影响各不相同；然而，患者中标准数量的增加导致死亡率累积上升。一个评分量表可以预测移植后的大致死亡率。这些发现表明，移植受者标准应关注高危标准的数量以及临床状况，而非单一危险因素的存在与否。
