Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Ann Thorac Surg. 2012 Mar;93(3):712-6. doi: 10.1016/j.athoracsur.2011.10.065. Epub 2012 Jan 5.
The aim of this study was to identify recipient factors that are associated with a high risk of graft failure after heart retransplantation (HRT).
The prospectively collected United Network for Organ Sharing registry was used to identify patients undergoing HRT among 24,477 patients who had undergone cardiac transplantation between 1997 and 2009. The primary outcome was graft failure within 1 year of HRT. The impact of 35 recipient variables on the primary outcome was tested in exploratory univariate logistic regression analysis. Those factors found to be significantly associated with graft failure were entered into a multivariable logistic regression model.
A total of 671 patients underwent HRT during the study period. Overall, 302 (45%) grafts failed after HRT at a mean follow-up of 4.3±3.7 years. Three recipient factors were found to be associated with 1-year graft failure in the multivariate model: older age, increasing serum creatinine, and mechanical ventilation before HRT. Moreover, each decade increase in recipient age was associated with a 20% increase in odds of 1-year graft failure (odds ratio, 1.02; 95% confidence interval, 1.01 to 1.04; p=0.005). Similarly, each 1-mg/dL increase in serum creatinine increased odds of graft failure by 58% (odds ratio, 1.58; 95% confidence interval, 1.27 to 1.97; p<0.001). Patients who were mechanically ventilated had a fourfold higher likelihood of 1-year graft failure (odds ratio, 4.32; 95% confidence interval, 2.28 to 8.18; p<0.001).
The risk of graft failure after HRT increases with an increasing number of significant recipient risk factors, namely older age, increasing serum creatinine, and mechanical ventilation. These risk factors should serve as relative contraindications to HRT, especially when present in combination, given the higher rate of graft failure in these patients.
本研究旨在确定心脏再次移植（HRT）后发生移植物衰竭的高风险的受者因素。
使用前瞻性收集的 United Network for Organ Sharing 登记处，确定 1997 年至 2009 年间接受心脏移植的 24477 例患者中进行 HRT 的患者。主要结局是 HRT 后 1 年内移植物衰竭。在探索性单变量逻辑回归分析中测试 35 个受者变量对主要结局的影响。将与移植物衰竭显著相关的因素纳入多变量逻辑回归模型。
研究期间共有 671 例患者接受 HRT。总体而言，在平均 4.3±3.7 年的随访中，HRT 后 302（45%）个移植物衰竭。在多变量模型中，有 3 个受者因素与 1 年移植物衰竭相关：年龄较大、血清肌酐升高和 HRT 前机械通气。此外，受者年龄每增加 10 年，1 年移植物衰竭的几率增加 20%（优势比，1.02；95%置信区间，1.01 至 1.04；p=0.005）。同样，血清肌酐每增加 1mg/dL，移植物衰竭的几率增加 58%（优势比，1.58；95%置信区间，1.27 至 1.97；p<0.001）。接受机械通气的患者 1 年移植物衰竭的可能性高 4 倍（优势比，4.32；95%置信区间，2.28 至 8.18；p<0.001）。
HRT 后移植物衰竭的风险随着受者危险因素数量的增加而增加，这些危险因素主要包括年龄较大、血清肌酐升高和机械通气。这些危险因素应作为 HRT 的相对禁忌证，尤其是在这些患者中，移植物衰竭的发生率较高时。
