Department of Paediatric Cardiothoracic transplantation, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
Arch Dis Child. 2010 Nov;95(11):883-7. doi: 10.1136/adc.2009.171348. Epub 2010 Jul 23.
Survival following cardiac transplantation in infancy has improved substantially. There is a growing shortage of donors, the impact of which may be offset by increase in ABO-incompatible transplants, size-mismatching and mechanical support. The authors reviewed their results and outcomes following infant listing for cardiac transplantation over 22 years.
Children <12 months at time of listing for cardiac transplant in 1987-2008 were identified using the departmental cardiopulmonary transplant database. Details were obtained from databases and hospital medical records and subdivided into two eras, 1987-1997 and 1998-2008.
In 1987-2008, 49 infants were listed, and 28 (57%) underwent cardiac transplantation (12 in 1987-1997 and 16 in 1998-2008). 15 patients (31%) died on the waiting list, 6 patients were delisted (5 of these because of recovery of cardiac function). There was a decrease in suitable donor offers from a mean of 36 per year in 1996-2000 to 11 per year in 2001-2006 (p=0.008). In 1998-2008, nine listed infants were on mechanical support; there were seven ABO-incompatible transplants, and all transplants were size-mismatched with donors on average 2.7 times heavier than recipients. Waiting times decreased from median 83 to 47 days. Six (21%) of the transplanted patients died, the majority in 1987-1997 and perioperatively.
There has been a fall in suitable donors for infant cardiac transplants over time despite increased demand. However, the introduction of size-mismatching, ABO-incompatible transplants and mechanical support has enabled an increase in the number of transplants to be carried out despite this fall in donor numbers. Outcomes following transplantation have improved over time.
婴儿心脏移植术后的存活率有了显著提高。供体短缺的情况越来越严重，这一情况的影响可能会因 ABO 不相容移植、大小不匹配和机械支持的增加而得到缓解。作者回顾了他们在过去 22 年中对婴儿心脏移植名单的结果和结果。
使用部门心肺移植数据库确定了 1987-2008 年期间在接受心脏移植时年龄小于 12 个月的儿童。从数据库和医院病历中获取详细信息，并分为两个时期，1987-1997 年和 1998-2008 年。
1987-2008 年，有 49 名婴儿被列入名单，其中 28 名（57%）接受了心脏移植（1987-1997 年 12 名，1998-2008 年 16 名）。15 名患者（31%）在等待名单上死亡，6 名患者被除名（其中 5 名是因为心脏功能恢复）。合适供体的提供数量从 1996-2000 年的平均每年 36 个减少到 2001-2006 年的每年 11 个（p=0.008）。1998-2008 年，有 9 名列入名单的婴儿接受机械支持；有 7 例 ABO 不相容移植，所有移植的供体与受体平均重量相差 2.7 倍。等待时间从中位数 83 天减少到 47 天。6 名（21%）移植患者死亡，大多数死亡发生在 1987-1997 年和围手术期。
尽管需求增加，但随着时间的推移，适合婴儿心脏移植的供体数量有所下降。然而，大小不匹配、ABO 不相容移植和机械支持的引入使得即使供体数量减少，也能够增加移植的数量。移植后的结果随着时间的推移而有所改善。
