Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Heart Lung Transplant. 2011 Dec;30(12):1389-94. doi: 10.1016/j.healun.2011.07.020. Epub 2011 Sep 9.
Large national registries lack information on social support, which is increasingly recognized as an important factor associated with improved outcomes after solid-organ transplantation. We examined our institutional database to identify social factors associated with improved outcomes after orthotopic heart transplantation (OHT).
Outcomes of OHT patients from 1995 to 2010 at our institution were retrospectively reviewed. Clinical data and social information were extracted from medical records. Patients were stratified by marital status at time of OHT listing. The examined outcome was 5-year survival, excluding deaths within 60 days, modeled using the Kaplan-Meier method. A Cox multivariable hazard regression model was constructed to assess the effect on 5-year survival.
Of 260 OHT recipients, 176 (68%) were men. Mean age was 49 ± 12 years and mean body mass index was 26.8 ± 5.0 kg/m(2). At the time of OHT listing, 175 patients (68%) were married. Before OHT, 25% were supported with ventricular assist devices and 17% were in the intensive care unit. Conditional Kaplan-Meier analysis revealed improved 5-year survival for married patients (84%) compared with unmarried patients (69%). After risk-adjustment with Cox analysis, being married improved 5-year survival (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.23-0.97; p = 0.042) and also improved 1-year survival (p = 0.02). Other social support variables (children, grandchildren, living arrangements, education, race, employment status) were not associated with mortality.
Married patients have improved survival after OHT compared with unmarried patients. Being married confers a powerful 5-year survival advantage after OHT. This benefit appears mediated by an improvement in survival during the first post-transplant year.
大型国家注册中心缺乏社会支持信息，而社会支持正日益被认为是与实体器官移植后改善结果相关的重要因素。我们检查了我们的机构数据库，以确定与原位心脏移植（OHT）后改善结果相关的社会因素。
回顾了我们机构 1995 年至 2010 年 OHT 患者的结果。从病历中提取临床数据和社会信息。根据 OHT 上市时的婚姻状况对患者进行分层。检查的结果是 5 年生存率，不包括 60 天内死亡的患者，使用 Kaplan-Meier 方法建模。构建 Cox 多变量风险回归模型以评估对 5 年生存率的影响。
在 260 例 OHT 受者中，有 176 例（68%）为男性。平均年龄为 49 ± 12 岁，平均体重指数为 26.8 ± 5.0 kg/m2。在 OHT 上市时，175 例患者（68%）已婚。在 OHT 之前，25%的患者使用心室辅助设备，17%的患者在重症监护病房。条件 Kaplan-Meier 分析显示，已婚患者的 5 年生存率（84%）高于未婚患者（69%）。通过 Cox 分析进行风险调整后，结婚可提高 5 年生存率（风险比 [HR]，0.47；95%置信区间 [CI]，0.23-0.97；p = 0.042）和 1 年生存率（p = 0.02）。其他社会支持变量（子女、孙子女、生活安排、教育、种族、就业状况）与死亡率无关。
与未婚患者相比，已婚患者 OHT 后的生存率提高。结婚可在 OHT 后获得强大的 5 年生存率优势。这种益处似乎是通过移植后第一年生存的改善介导的。
