Tang Liwen, Du Wei, Delius Ralph E, L'Ecuyer Thomas J, Zilberman Mark V
Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI 48201, USA.
Pediatr Transplant. 2010 Sep 1;14(6):741-5. doi: 10.1111/j.1399-3046.2010.01300.x. Epub 2010 Mar 4.
A major limitation to success in pediatric heart transplantation is donor organ shortage. While the use of allografts from donors larger than the recipient is accepted, the use of undersized donor grafts is generally discouraged. Using the UNOS database, we wanted to evaluate whether using smaller donor hearts affects the short- and long-term survival of pediatric heart transplant patients. A retrospective analysis of data entered into the UNOS database from April 1994 to May 2008 was performed. Pediatric heart transplant recipients (ages 0-18 yr) with DRWR <2.0 were identified and divided into two groups: Low-DRWR (<0.8) and Ideal-DRWR (0.8-2.0). Patients' demographics, pretransplant diagnoses, age at transplantation, severity of pretransplant condition, and rate of complications prior to hospital discharge after transplantation were noted. Fisher's exact, chi-square, and Wilcoxon rank sum tests were used to compare patients' baseline characteristics. Kaplan-Meier curves and Cox proportional hazard regression were used to compare patients' survival and to identify independent risk factors for outcomes. There were 3048 patients (204 with Low- and 2844 with Ideal-DRWR). The Low-ratio group patients were older (8.3 vs. 6.9 yr; p = 0.001), there was a slight male predominance in the Low-DRWR group (p = 0.055). The Low-DRWR group had longer transplant wait time than the Ideal-DRWR group (97 vs. 85 days; p = 0.04). The groups did not differ in race, primary diagnoses, severity of pretransplant condition (medical urgency status, need for ventilation, inotropic support, ECMO, nitric oxide, or dialysis, the PVR for those with bi-ventricular anatomy), or post-transplant complications (length of stay, need for inotropic support, dialysis, and rate of infections). The Low-DRWR patients had less episodes of acute rejection during the first-post-transplant month. Infants with DRWR 0.5-0.59 had lower 30-day survival rate (p = 0.045). There was no difference in short- and long-term survival between the patients with DRWR 0.6-0.79 and DRWR 0.8-2.0. Use of smaller allografts (DRWR 0.6-0.8) has no negative impact on the short- and long-term survival of pediatric heart transplant patients.
小儿心脏移植成功的一个主要限制因素是供体器官短缺。虽然使用比受体大的供体的同种异体移植物是被接受的，但一般不鼓励使用尺寸过小的供体移植物。利用器官共享联合网络（UNOS）数据库，我们想评估使用较小的供体心脏是否会影响小儿心脏移植患者的短期和长期生存。对1994年4月至2008年5月录入UNOS数据库的数据进行了回顾性分析。确定了供体与受体体重比（DRWR）<2.0的小儿心脏移植受者（年龄0 - 18岁），并将其分为两组：低DRWR组（<0.8）和理想DRWR组（0.8 - 2.0）。记录了患者的人口统计学资料、移植前诊断、移植时年龄、移植前病情严重程度以及移植后出院前的并发症发生率。采用Fisher精确检验、卡方检验和Wilcoxon秩和检验来比较患者的基线特征。使用Kaplan - Meier曲线和Cox比例风险回归来比较患者的生存率，并确定影响预后的独立危险因素。共有3048例患者（低DRWR组204例，理想DRWR组2844例）。低比例组患者年龄较大（8.3岁对6.9岁；p = 0.001），低DRWR组男性略占优势（p = 0.055）。低DRWR组的移植等待时间比理想DRWR组更长（97天对85天；p = 0.04）。两组在种族、主要诊断、移植前病情严重程度（医疗紧急状态、是否需要通气、使用血管活性药物支持、体外膜肺氧合、一氧化氮或透析，双心室解剖结构患者的肺血管阻力）或移植后并发症（住院时间、是否需要血管活性药物支持、透析以及感染率）方面无差异。低DRWR组患者在移植后第一个月的急性排斥发作次数较少。DRWR为0.5 - 0.59的婴儿30天生存率较低（p = 0.045）。DRWR为0.6 - 0.79和DRWR为0.8 - 2.0的患者在短期和长期生存方面无差异。使用较小的同种异体移植物（DRWR 0.6 - 0.8）对小儿心脏移植患者的短期和长期生存没有负面影响。
