Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
Ann Thorac Surg. 2010 Jul;90(1):168-75. doi: 10.1016/j.athoracsur.2010.03.043.
Chronic allograft vasculopathy (CAV) is a major cause of long-term complications and mortality after heart transplantation. Although recipient factors have been implicated, little is known of the role of donor factors in CAV development. We sought to identify donor factors associated with development of CAV after heart transplantation.
We reviewed the United Network for Organ Sharing heart transplant database from August 1987 to May 2008. Univariate and multivariate analyses were performed to assess the association between donor variables and the onset of CAV for adult recipients. Donor age was matched to recipient age and analyzed with respect to development of CAV.
Of the 39,704 recipients, a total of 11,714 (29.5%) experienced CAV. Multivariate analysis demonstrated seven donor factors as independent predictors of CAV: age, ethnicity, sex, weight, history of diabetes, hypertension, and tobacco use. When matching young donors (0 to 19.9 years) and old donors (> or =50 years) to each recipient age group, older donors (> or =50 years) conferred a higher risk of developing CAV. Further modeling demonstrated that for each recipient group, older donor age (> or =50 years) conferred a higher risk of CAV development compared with younger donor age (0 to 19.9 years; p < 0.0001).
Donor factors including sex, hypertension, diabetes, and tobacco use are independently associated with recipient CAV. Older donor age confers a greater risk of CAV development regardless of the age of the recipient. A heightened awareness for the development of CAV is warranted when using older donors in adult cardiac transplantation, in particular with recipients 40 years of age or older.
慢性移植心脏血管病（CAV）是心脏移植后长期并发症和死亡的主要原因。虽然已经涉及到受者因素，但对于供者因素在 CAV 发展中的作用知之甚少。我们试图确定与心脏移植后 CAV 发展相关的供者因素。
我们回顾了 1987 年 8 月至 2008 年 5 月期间的 United Network for Organ Sharing 心脏移植数据库。进行了单变量和多变量分析，以评估供者变量与成人受者 CAV 发病之间的关系。供者年龄与受者年龄相匹配，并分析了 CAV 的发病情况。
在 39704 名受者中，共有 11714 名（29.5%）发生了 CAV。多变量分析表明，7 个供者因素是 CAV 的独立预测因子：年龄、种族、性别、体重、糖尿病史、高血压和吸烟史。当将年轻供者（0 至 19.9 岁）和老年供者（≥50 岁）与每个受者年龄组相匹配时，老年供者（≥50 岁）发生 CAV 的风险更高。进一步的模型表明，对于每个受者组，与年轻供者（0 至 19.9 岁）相比，老年供者（≥50 岁）的供者年龄更高，发生 CAV 的风险更高（p<0.0001）。
包括性别、高血压、糖尿病和吸烟在内的供者因素与受者 CAV 独立相关。无论受者年龄如何，老年供者的年龄越大，发生 CAV 的风险越高。在成人心脏移植中使用老年供者时，特别是在 40 岁或以上的受者中，需要更加警惕 CAV 的发生。
