Boucek Mark M, Mashburn Christine, Dunn Susan M, Frizell Rebecca, Edwards Leah, Pietra Biagio, Campbell David
Department of Pediatrics, Joe DiMaggio Children's Hospital, Hollywood, FL 33021, USA.
N Engl J Med. 2008 Aug 14;359(7):709-14. doi: 10.1056/NEJMoa0800660.
In three infants awaiting orthotopic cardiac transplantation, transplantation was successfully performed with the use of organs from donors who had died from cardiocirculatory causes. The three recipients had blood group O and were in the highest-risk waiting-list category. The mean age of donors was 3.7 days, and the mean time to death after withdrawal from life support was 18.3 minutes. The 6-month survival rate was 100% for the 3 transplant recipients and 84% for 17 control infants who received transplants procured through standard organ donation. The mean number of rejection episodes among the three infants during the first 6 months after surgery was 0.3 per patient, as compared with 0.4 per patient among the controls. Echocardiographic measures of ventricular size and function at 6 months were similar among the three infants and the controls (left ventricular shortening fraction, 43.6% and 44.9%, respectively; P=0.73). No late deaths (within 3.5 years) have occurred in the three infants, and they have had functional and immunologic outcomes similar to those of controls. Mortality while awaiting a transplant is an order of magnitude higher in infants than in adults, and donors who died from cardiocirculatory causes offer an opportunity to decrease this waiting-list mortality.
在三名等待原位心脏移植的婴儿中，使用死于心脏循环系统原因的供体器官成功进行了移植。这三名受体血型均为O型，处于等待名单中的最高风险类别。供体的平均年龄为3.7天，停止生命支持后的平均死亡时间为18.3分钟。3名移植受体的6个月生存率为100%，17名通过标准器官捐赠获得移植的对照婴儿的6个月生存率为84%。三名婴儿术后前6个月的平均排斥反应次数为每人0.3次，而对照组为每人0.4次。三名婴儿和对照组在6个月时的心室大小和功能的超声心动图测量结果相似（左心室缩短分数分别为43.6%和44.9%；P=0.73）。这三名婴儿未发生晚期死亡（3.5年内），其功能和免疫结果与对照组相似。婴儿等待移植期间的死亡率比成人高一个数量级，死于心脏循环系统原因的供体提供了一个降低等待名单死亡率的机会。
