Auerbach Scott R, Richmond Marc E, Chen Jonathan M, Mosca Ralph S, Quaegebeur Jan M, Addonizio Linda J, Hsu Daphne T, Lamour Jacqueline M
Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, Denver, CO, USA.
Pediatr Cardiol. 2012 Jan;33(1):49-54. doi: 10.1007/s00246-011-0077-7. Epub 2011 Sep 4.
Identification of heart transplant recipients at highest risk for a poor outcome could lead to improved posttransplantation survival. A chart review of primary heart transplantations from 1993 to 2006 was performed. Analysis was performed to evaluate the risk of graft loss for those with a transplantation age less than 1 year, congenital heart disease (CHD), elevated pulmonary vascular resistance (index > 6), positive panel reactive antibody or crossmatch, liver or renal dysfunction, mechanical ventilation, or mechanical circulatory support (MCS). Primary transplantation was performed for 189 patients. Among these patients, 37% had CHD, 23% had mechanical ventilation, and 6% had renal dysfunction. Overall graft survival was 82% at 1 year and 68% at 5 years. The univariate risk factors for graft loss included mechanical ventilation (hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.15-3.18), CHD (HR, 1.68; 95% CI, 1.04-2.70), and renal dysfunction (HR, 3.05; 95% CI, 1.34-6.70). The multivariate predictors of graft loss were CHD (HR, 1.8; 95% CI, 1.02-2.64), mechanical ventilation (HR, 1.9; 95% CI, 1.13-3.10), and the presence of two or more statistically significant univariate risk factors (SRF) (HR, 3.8; 95% CI, 2.00-7.32). Mechanical ventilation, CHD, and the presence of two or more SRFs identify pediatric patients at higher risk for graft loss and should be considered in the management of children with end-stage heart failure.
识别心脏移植受者中预后不良风险最高的人群，可能会改善移植后的生存率。对1993年至2006年的初次心脏移植进行了图表回顾。分析评估了移植年龄小于1岁、患有先天性心脏病（CHD）、肺血管阻力升高（指数>6）、群体反应性抗体或交叉配型阳性、肝或肾功能不全、机械通气或机械循环支持（MCS）的患者发生移植物丢失的风险。对189例患者进行了初次移植。在这些患者中，37%患有CHD，23%接受了机械通气，6%存在肾功能不全。1年时总体移植物生存率为82%，5年时为68%。移植物丢失的单因素风险因素包括机械通气（风险比[HR]，1.9；95%置信区间[CI]，1.15 - 3.18）、CHD（HR，1.68；95%CI，1.04 - 2.70）和肾功能不全（HR，3.05；95%CI，1.34 - 6.70）。移植物丢失的多因素预测因素为CHD（HR，1.8；95%CI，1.02 - 2.64）、机械通气（HR，1.9；95%CI，1.13 - 3.10）以及存在两个或更多具有统计学意义的单因素风险因素（SRF）（HR，3.8；95%CI，2.00 - 7.32）。机械通气、CHD以及存在两个或更多SRF可识别出移植物丢失风险较高的儿科患者，在终末期心力衰竭患儿的管理中应予以考虑。
