Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
Am J Transplant. 2011 Dec;11(12):2692-9. doi: 10.1111/j.1600-6143.2011.03723.x. Epub 2011 Aug 30.
We sought to evaluate trends in overall and race-specific pediatric heart transplant (HT) wait-list mortality in the United States (US) during the last 20 years. We identified all children <18 years old listed for primary HT in the US during 1989-2009 (N = 8096, 62% White, 19% Black, 13% Hispanic and 6% Other) using the Organ Procurement and Transplant Network database. Wait-list mortality was assessed in four successive eras (1989-1994, 1995-1999, 2000-2004 and 2005-2009). Overall wait-list mortality declined in successive eras (26%, 23%, 18% and 13%, respectively). The decline across eras remained significant in adjusted analysis (hazard ratio [HR] 0.70 in successive eras, 95% confidence interval [CI], 0.67-0.74) and was 67% lower for children listed during 2005-2009 versus those listed during 1989-1994 (HR 0.33; CI, 0.28-0.39). In models stratified by race, wait-list mortality decreased in all racial groups in successive eras. In models stratified by era, minority children were not at higher risk of wait-list mortality in the most recent era. We conclude that the risk of wait-list mortality among US children listed for HT has decreased by two-thirds during the last 20 years. Racial gaps in wait-list mortality present variably in the past are not present in the current era.
我们试图评估过去 20 年美国（US）儿科心脏移植（HT）候补名单死亡率的总体趋势和种族特异性趋势。我们使用器官采购和移植网络数据库，确定了 1989 年至 2009 年期间在美国接受主要 HT 候补名单的所有年龄小于 18 岁的儿童（N = 8096，62%为白人，19%为黑人，13%为西班牙裔，6%为其他）。在四个连续时期评估了候补名单死亡率（1989-1994 年、1995-1999 年、2000-2004 年和 2005-2009 年）。在连续时期，候补名单死亡率均有所下降（分别为 26%、23%、18%和 13%）。调整分析显示，各时期的下降趋势仍然显著（连续时期的危险比[HR]为 0.70，95%置信区间[CI]为 0.67-0.74），与 1989-1994 年相比，2005-2009 年列入候补名单的儿童的死亡率降低了 67%（HR 0.33；CI，0.28-0.39）。在按种族分层的模型中，所有种族群体在连续时期的候补名单死亡率均有所下降。在按时期分层的模型中，少数族裔儿童在最近时期的候补名单死亡率并不更高。我们的结论是，在过去的 20 年中，美国接受 HT 候补名单的儿童的候补名单死亡率降低了三分之二。过去候补名单死亡率存在种族差异，但在当前时期并不存在。
