Tang Liwen, Du Wei, L'Ecuyer Thomas J
Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
Pediatr Transplant. 2011 Jun;15(4):430-6. doi: 10.1111/j.1399-3046.2010.01445.x.
PRF is encountered in 10-13% of adult heart transplants. Only one study of a single center's experience with PRF has been reported in pediatric patients. This study examines the effect of PRF on pediatric heart transplant outcome using the UNOS database. A total of 3598 patients met inclusion criteria, of whom 254 (7%) had PRF. The PRF group comprised 31 recipients requiring PRE and 223 recipients requiring POST. Compared with No-PRF patients, PRE patients had similar survival rate and POST patients had decreased survival rate at 30 days, one, five, and 10-yr post-transplant (p < 0.001). PRF patients also had significantly lower graft survival at one, five, and 10 yr (p < 0.001). Risk factors for developing PRF included ECMO, ventilator, and inotropic support at listing and CHD as the listing diagnosis. PRF increased the duration of hospital stay and the incidence of chronic severe renal dysfunction. PRF that requires POST (whether or not it began pretransplant) has a significant negative impact on pediatric heart transplant outcome. Specific characteristics identify patients at particular high risk of developing PRF.
10%至13%的成人心脏移植会出现原发性移植物功能衰竭（PRF）。儿科患者中，仅有一项关于单一中心PRF经验的研究被报道。本研究使用器官共享联合网络（UNOS）数据库，考察PRF对儿科心脏移植结果的影响。共有3598名患者符合纳入标准，其中254名（7%）出现PRF。PRF组包括31名需要移植前机械辅助（PRE）的受者和223名需要移植后机械辅助（POST）的受者。与未出现PRF的患者相比，移植前机械辅助患者在移植后30天、1年、5年和10年的生存率相似，而移植后机械辅助患者的生存率则有所下降（p<0.001）。PRF患者在1年、5年和10年时的移植物存活率也显著较低（p<0.001）。发生PRF的危险因素包括体外膜肺氧合（ECMO）、呼吸机、登记时的正性肌力支持以及登记诊断为先天性心脏病（CHD）。PRF增加了住院时间和慢性严重肾功能不全的发生率。需要移植后机械辅助的PRF（无论是否在移植前开始）对儿科心脏移植结果有显著负面影响。特定特征可识别发生PRF风险特别高的患者。
