Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
J Heart Lung Transplant. 2011 Sep;30(9):1033-43. doi: 10.1016/j.healun.2011.05.005. Epub 2011 Jun 17.
Despite significant advances in cardiac allograft preservation, the optimal preservative solution is unknown. We evaluated the impact of the most commonly used solutions in the USA, the University of Wisconsin solution (UW) and Celsior solution (CS), on outcomes after orthotopic heart transplantation (OHT).
We retrospectively reviewed adult OHT recipients in the United Network for Organ Sharing (UNOS) database. Primary stratification was by preservation solution. The primary end-point was short-term survival (30 days and 1 year). Secondary end-points included common post-operative complications. Subgroup analysis was performed in high-risk allografts (donor age >50 years or ischemic time >4 hours). Risk-adjusted multivariate Cox proportional hazard regression was used to assess survival.
From 2004 to 2009, 4,910 patients (3,107 UW and 1,803 CS) with sufficient preservation solution information for analysis underwent OHT. Baseline characteristics were well-matched between the two groups. UW was associated with a small but significantly improved survival compared with CS at 30 days (96.7% vs 95.4%, p = 0.02) and 1 year (89.6% vs 87.0%, p < 0.01). These survival differences persisted on multivariate analysis at 30 days (HR 1.47 [1.02 to 2.13], p < 0.05) and 1 year (HR 1.40 [1.14 to 1.73], p < 0.01). In the 1,455 patients with high-risk allografts, preservation with UW was associated with improved survival compared with CS at 30 days (94.3% vs 91.3%, p < 0.01) and at 1 year (84.2% vs 80.19%, p < 0.01), a difference that was significant according to multivariate Cox analysis at 30 days (HR 2.29 [1.39 to 3.76], p < 0.01) and 1 year (HR 1.61 [1.17 to 2.21], p < 0.01).
Preservation with UW solution is associated with improved short-term survival compared with CS. Patients undergoing OHT with high-risk allografts have a similar survival benefit.
尽管心脏移植保存技术取得了显著进展，但仍不清楚哪种保存液最佳。我们评估了美国最常用的保存液，即威斯康星大学溶液（UW）和塞尔索溶液（CS），对原位心脏移植（OHT）后结果的影响。
我们回顾性分析了美国器官共享联合网络（UNOS）数据库中的成人 OHT 受者。主要分层依据为保存液。主要终点是短期生存（30 天和 1 年）。次要终点包括常见的术后并发症。在高危供体（供体年龄>50 岁或缺血时间>4 小时）中进行亚组分析。采用风险调整多变量 Cox 比例风险回归评估生存情况。
2004 年至 2009 年，4910 例（3107 例 UW 和 1803 例 CS）患者具有足够的保存液信息进行分析，接受 OHT。两组之间的基线特征匹配良好。与 CS 相比，UW 在 30 天（96.7%比 95.4%，p=0.02）和 1 年（89.6%比 87.0%，p<0.01）时的生存率略有提高，但差异有统计学意义。多变量分析在 30 天（HR 1.47[1.02 至 2.13]，p<0.05）和 1 年（HR 1.40[1.14 至 1.73]，p<0.01）时也存在这种生存差异。在 1455 例高危供体中，与 CS 相比，UW 保存与 30 天（94.3%比 91.3%，p<0.01）和 1 年（84.2%比 80.19%，p<0.01）时的生存率提高相关，多变量 Cox 分析在 30 天（HR 2.29[1.39 至 3.76]，p<0.01）和 1 年（HR 1.61[1.17 至 2.21]，p<0.01）时也存在显著差异。
与 CS 相比，UW 保存液保存与短期生存率提高相关。接受高危供体 OHT 的患者具有相似的生存获益。
