Ongcharit P, Wongkietkachorn K, Sritangsirikul S, Namchaisiri J, Singhatanatkit S, Luengtaviboon K, Benjacholamas V, Ongcharit C
Cardiothoracic Surgery Unit, Department of Surgery, Chulalongkorn Hospital, Bangkok, Thailand.
Transplant Proc. 2008 Oct;40(8):2591-3. doi: 10.1016/j.transproceed.2008.08.077.
After many years, heart transplantation is still the most accepted treatment for end-stage heart disease. A heart transplantation program was started at our hospital in December 1987 as the first intrathoracic organ transplantation in Southeast Asia. Herein, we have reviewed our 20 years of experience from 1987 to 2007.
We followed every individual within our 52-patient cohort for up to 20 years. Three eras were studied: 1987 to 1995, 1996 to 2002, and 2003 to 2007. End points were survival, rejection, infection event, and graft coronary artery disease (CAD).
There were 52 patients (39 males and 12 females). The mean age was 41.7 years (range, 12-23 years). Perioperative mortality (within 1 month) was 13.4% (n = 7) due to graft failure (n = 2), rejection (n = 3), infection (n = 1), on pulmonary hypertension (n = 1). Medium-term mortality (1-12 months) was 30.7% (n = 16) due to rejection (n = 8), infection (n = 7), or CAD (n = 1). After 1 year causes of death were rejection (n = 4), infection (n = 4), renal failure (n = 2), or CAD (n = 1). Overall actuarial 1-, 5-, and 10-year survival rates for all recipients were 54.7%, 43.3%, and 32.5%, respectively. The first patient in this series is still alive. For the period 2003 to 2007, actuarial 1-year and 4-year survival rates for all recipients were both 77.8%. The rate of rejection was reduced to just one event during this period. All surviving patients were NYHA Functional class I and II; 86% went back to work, leading almost normal lives.
Improved survival in the current era may be attributed to better organ preservation, improved immunosuppression, and control of infection, as well as less graft CAD. Those who survive more than 1 year have a good quality of life.
多年来，心脏移植仍是终末期心脏病最被认可的治疗方法。1987年12月，我院启动了心脏移植项目，这是东南亚首例胸腔内器官移植。在此，我们回顾了1987年至2007年这20年的经验。
我们对52例患者组成的队列中的每一个体进行了长达20年的随访。研究了三个时期：1987年至1995年、1996年至2002年、2003年至2007年。终点指标为生存率、排斥反应、感染事件和移植冠状动脉疾病（CAD）。
有52例患者（39例男性和12例女性）。平均年龄为41.7岁（范围12 - 23岁）。围手术期死亡率（1个月内）为13.4%（n = 7），原因包括移植失败（n = 2）、排斥反应（n = 3）、感染（n = 1）、肺动脉高压（n = 1）。中期死亡率（1 - 12个月）为30.7%（n = 16），原因包括排斥反应（n = 8）、感染（n = 7）或CAD（n = 1）。1年后的死亡原因包括排斥反应（n = 4）、感染（n = 4）、肾衰竭（n = 2）或CAD（n = 1）。所有受者的总体精算1年、5年和10年生存率分别为54.7%、43.3%和32.5%。该系列中的首例患者仍然存活。2003年至2007年期间，所有受者的精算1年和4年生存率均为77.8%。在此期间，排斥反应发生率降至仅1例。所有存活患者均为纽约心脏协会（NYHA）功能I级和II级；86%的患者重返工作岗位，过着几乎正常的生活。
当前时代生存率的提高可能归因于更好的器官保存、改进的免疫抑制、感染控制以及移植CAD的减少。存活超过1年的患者生活质量良好。
