Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.
J Heart Lung Transplant. 2010 Sep;29(9):966-72. doi: 10.1016/j.healun.2010.05.003. Epub 2010 Jun 26.
Donor and recipient risk factors for rejection and infection have been well characterized. The contribution of demographic factors, especially age at the time of transplantation to morbidity and mortality due to rejection and infection, is much less well understood.
Using parametric hazard analysis and multivariate risk-factor equations for infection and rejection events, we quantitatively determined the relationship of fundamental demographic variables (age, race and gender) to infection and rejection. These analyses were conducted with respect to date of transplant and age at the time of transplantation. The patient group consisted of all primary heart transplants performed at the University of Alabama at Birmingham during the years 1990 to 2007 (n = 526).
Risk factors for rejection within 12 months post-transplantation were date of transplant (p < 0.0001) and age at the time of transplantation (young adults 10 to 30 years of age, p < 0.0001). Risk factors for infection were date of transplant (p < 0.0001) and age at the time of transplantation (young children and older adults, p < 0.0001). There were three immunosuppressive eras in 1990 to 2007. Notably, although the proportion of patients experiencing rejection and infection events decreased during each successive immunosuppressive era, the relative relationship of infection to rejection, as well as age at the time of transplantation, remained similar into the most recent era. The maximal frequency of rejection events and rejection death occurred among patients transplanted at ages 10 to 30 years. Conversely, the frequency of infection events was minimal within the same group. In the oldest and youngest patients receiving transplants, infection was the predominant cause of death and rates of rejection events decreased.
These data show that evolving immunosuppressive strategies have successfully reduced rejection and infection frequencies, and those patients transplanted at 30 to 60 years of age have the lowest frequency of rejection/infection events. However, individuals transplanted at younger or older ages, especially non-white recipients in the 10- to 30-year age group, experience significantly more infection or rejection. Therefore, programs should increase the level of surveillance in these patients and consider modification of immunosuppressive regimens in order to lower the frequency of infection and rejection events.
人们已经充分了解了供体和受体排斥反应和感染的风险因素。但是，对于导致排斥反应和感染的发病率和死亡率的人口统计学因素（尤其是移植时的年龄）的影响，人们的了解要少得多。
使用参数风险分析和感染与排斥反应的多变量风险因素方程，我们定量确定了基本人口统计学变量（年龄、种族和性别）与感染和排斥反应的关系。这些分析是针对移植日期和移植时的年龄进行的。患者组由 1990 年至 2007 年期间在阿拉巴马大学伯明翰分校进行的所有原发性心脏移植组成（n=526）。
移植后 12 个月内排斥反应的危险因素是移植日期（p<0.0001）和移植时的年龄（10 至 30 岁的年轻人，p<0.0001）。感染的危险因素是移植日期（p<0.0001）和移植时的年龄（幼儿和老年人，p<0.0001）。在 1990 年至 2007 年期间，有三个免疫抑制时代。值得注意的是，尽管在每个连续的免疫抑制时代中，经历排斥反应和感染事件的患者比例都有所下降，但感染与排斥反应的相对关系以及移植时的年龄仍保持相似，直到最近的时代。排斥反应事件和排斥反应死亡的发生率最高的是在 10 至 30 岁之间接受移植的患者。相反，在同一组中，感染事件的发生率最低。在接受移植的最年长和最年轻的患者中，感染是死亡的主要原因，排斥反应事件的发生率降低。
这些数据表明，不断发展的免疫抑制策略已成功降低了排斥反应和感染的频率，而在 30 至 60 岁之间接受移植的患者发生排斥反应/感染事件的频率最低。但是，在较年轻或较年长的患者（尤其是在 10 至 30 岁年龄组的非白人患者）中，感染或排斥反应的发生率明显更高。因此，应增加对这些患者的监测水平，并考虑修改免疫抑制方案，以降低感染和排斥反应事件的发生率。
