Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
J Heart Lung Transplant. 2009 Dec;28(12):1285-91. doi: 10.1016/j.healun.2009.05.003. Epub 2009 Sep 26.
Post-transplant survival in pediatric heart transplant (HT) recipients has improved for recent era recipients. However, the era effect has not been assessed after adjusting for baseline risk factors in HT recipients.
We compared baseline characteristics and 5-year survival in pediatric HT recipients in three eras (early: July 1994 to June 1997, n = 1,153; middle: July 1997 to June 2000, n = 1,085; recent: July 2000 to June 2003, n = 1,138) for all recipients <18 years of age who were reported to the registry of the International Society for Heart and Lung Transplantation (n = 3,376). We used a Cox proportional hazards model for determining risk-adjusted era effect on death or graft loss (retransplant).
There were more retransplants and more recipients had pre-formed antibodies in the recent eras. Recent era recipients were more likely to be supported by inotropes, ventilator, mechanical support and dialysis at the time of transplant. Five-year survival was better for patients who underwent HT in the middle era (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.68 to 0.93, p = 0.003) and the recent era (HR 0.70, CI 0.60 to 0.82, p < 0.001) as compared with those in the early era, adjusted for baseline risk factors. The determinants of conditional 5-year survival in HT recipients who survived the first 6 months were recipient and donor age, recipient gender, retransplant, pre-formed antibodies and inotropes, but not transplant era.
Despite the worse baseline risk profile of pediatric HT recipients in recent years, their risk-adjusted survival during the first 5 years after transplant has improved. The entire era effect appears to be due to improved survival during the first 6 months post-transplant.
在儿科心脏移植（HT）受者中，最近时代受者的移植后存活率有所提高。然而，在调整 HT 受者的基线风险因素后，尚未评估时代效应。
我们比较了三个时代（早期：1994 年 7 月至 1997 年 6 月，n = 1153；中期：1997 年 7 月至 2000 年 6 月，n = 1085；近期：2000 年 7 月至 2003 年 6 月，n = 1138）中所有 <18 岁并向国际心肺移植协会注册中心报告的儿科 HT 受者的基线特征和 5 年生存率（n = 3376）。我们使用 Cox 比例风险模型来确定死亡或移植物丢失（再次移植）的风险调整时代效应。
近期时代的再次移植和预先形成抗体的受者更多。近期时代的受者在移植时更有可能需要正性肌力药、呼吸机、机械支持和透析支持。与早期时代相比，中期时代（危险比[HR]0.79，95%置信区间[CI]0.68 至 0.93，p = 0.003）和近期时代（HR 0.70，CI 0.60 至 0.82，p < 0.001）的 HT 受者 5 年生存率更好，调整了基线风险因素。在存活前 6 个月的 HT 受者中，5 年生存的条件因素包括受者和供者年龄、受者性别、再次移植、预先形成的抗体和正性肌力药，但不包括移植时代。
尽管近年来儿科 HT 受者的基线风险状况较差，但他们在移植后前 5 年的风险调整生存率有所提高。整个时代效应似乎是由于移植后前 6 个月的生存率提高所致。
