Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA.
J Heart Lung Transplant. 2011 Mar;30(3):282-8. doi: 10.1016/j.healun.2010.08.031. Epub 2010 Oct 25.
Survival after pediatric heart transplant has improved over time, as has the incidence of overall rejection. We studied the effect of era on the occurrence and outcome of rejection with hemodynamic compromise (HC).
Data from 2227 patients who received allografts between 1993 and 2006 at 36 centers in the Pediatric Heart Transplant Study were analyzed to determine incidence, outcome, and risk factors for rejection with HC in early (1993-1999) and recent (2000-2006) eras. Rejection with HC was classified as severe (RSHC) when inotropes were used for circulatory support and mild (RMHC) when inotropes were not used.
Of 1217 patients with any episode of rejection, 541 had rejection with HC. Freedom from RMHC improved at 1 year (81% vs 90%, p < 0.001) and at 5 years (74% vs 85%, p < 0.001) in the early vs recent eras, but freedom from RSHC was similar between eras (93% vs 95% at 1 year and 85% vs 87% at 5 years, p = 0.24). Survival after RSHC (63% at 1 year and 49% at 5 years) was worse than after RMHC (87% at 1 year and 72% at 5 years, p < 0.001) and did not change over time. Risk factors for RSHC were non-white race (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.29-2.32, p < 0.01), older age (HR, 2.85; 95% CI, 1.24-6.53; p = 0.01), and non-A blood type (HR, 1.51;, 95% CI, 1.11-2.04,; p = 0.01), but the only risk factor for RMHC was earlier era of transplant (HR, 1.94; 95% CI, 1.56-2.41; p < 0.001).
The incidence of RMHC has declined over time but the same era effect has not occurred with RSHC. Close follow-up after RSHC is crucial because mortality is so high.
随着时间的推移，儿科心脏移植患者的存活率得到了提高，整体排斥反应的发生率也有所上升。我们研究了时代变化对伴有血流动力学障碍的排斥反应（HC）的发生和结局的影响。
对 1993 年至 2006 年在 36 个中心接受同种异体移植的 2227 例患者的数据进行分析，以确定早期（1993-1999 年）和近期（2000-2006 年）两个时期伴有 HC 的排斥反应的发生率、结局和危险因素。伴有 HC 的排斥反应分为严重（RSHC）和轻度（RMHC），前者需要使用正性肌力药物支持循环，后者不需要。
在 1217 例出现任何排斥反应的患者中，有 541 例出现伴有 HC 的排斥反应。早期与近期相比，RMHC 的 1 年无复发率（81%比 90%，p<0.001）和 5 年无复发率（74%比 85%，p<0.001）均有所提高，但 RSHC 的无复发率无差异（1 年时为 93%比 95%，5 年时为 85%比 87%，p=0.24）。RSHC 后的生存率（1 年时为 63%，5 年时为 49%）差于 RMHC（1 年时为 87%，5 年时为 72%，p<0.001），且无时间变化。RSHC 的危险因素是非白人种族（危险比 [HR]，1.73；95%置信区间 [CI]，1.29-2.32，p<0.01）、年龄较大（HR，2.85；95% CI，1.24-6.53；p=0.01）和非 A 血型（HR，1.51；95% CI，1.11-2.04，p=0.01），但 RMHC 的唯一危险因素是移植的早期时代（HR，1.94；95% CI，1.56-2.41；p<0.001）。
RMHC 的发生率随着时间的推移而下降，但 RSHC 并未出现相同的时代效应。RSHC 后需要密切随访，因为死亡率如此之高。
