Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ann Thorac Surg. 2012 Mar;93(3):699-704. doi: 10.1016/j.athoracsur.2011.09.037. Epub 2012 Jan 5.
This case-control study was conducted to identify factors predictive of 10-year survival after orthotopic heart transplantation (OHT).
Prospectively collected data from the United Network for Organ Sharing registry were reviewed to identify adult patients undergoing OHT between 1987 and 1999 (N=22,385) who had survived 10 years. Controls were those who had died within 10 years of OHT. Factors associated with 10-year survival were identified with multivariate logistic regression analysis. Lowess smoothing plots were used to identify linear breakpoints in continuous variables, and splines were incorporated when appropriate.
There were 9,404 ten-year survivors (42%; mean follow-up, 14.0±3.0 years) and 10,373 controls (46%) with a mean survival of 3.7±3.3 years post-OHT. Predictors of 10-year survival in the optimal multivariate model were age younger than 55 (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.10 to 1.38; p<0.001), white race (OR, 1.35; 95% CI, 1.17 to 1.56; p<0.001), shorter ischemic time (OR, 1.11; 95% CI, 1.05 to 1.18; p<0.001), younger donor age (OR, 1.01; 95% CI, 1.01 to 1.02; p<0.001), annual center volume of 9 or more (OR, 1.31; 95% CI, 1.17 to 1.47; p<0.001), mechanical ventilation (OR, 0.53; 95% CI, 0.36 to 0.78; p=0.001), and diabetes (OR, 0.67; 95% CI, 0.57 to 0.78; p<0.001).
Age younger than 55 years, annual center volume of 9 or more, white race, shorter ischemic time, and younger donor age improved the likelihood of 10-year survival after OHT. Mechanical ventilation and diabetes reduced this likelihood. These data should serve as a useful guide to long-term prognostication in adult OHT.
本病例对照研究旨在确定与原位心脏移植（OHT）后 10 年生存相关的预测因素。
回顾性分析 1987 年至 1999 年间接受 OHT 的美国器官共享联合网络注册数据库中收集的前瞻性数据，确定存活 10 年的成年患者（N=22385）。对照组为 OHT 后 10 年内死亡的患者。采用多变量逻辑回归分析确定与 10 年生存率相关的因素。采用低阶平滑图识别连续变量中的线性断点，并在适当情况下纳入样条。
共有 9404 例 10 年幸存者（42%；平均随访 14.0±3.0 年）和 10373 例对照组（46%），OHT 后平均生存时间为 3.7±3.3 年。最佳多变量模型中 10 年生存率的预测因素为年龄<55 岁（比值比[OR]，1.24；95%置信区间[CI]，1.10 至 1.38；p<0.001）、白种人（OR，1.35；95%CI，1.17 至 1.56；p<0.001）、缺血时间较短（OR，1.11；95%CI，1.05 至 1.18；p<0.001）、供体年龄较年轻（OR，1.01；95%CI，1.01 至 1.02；p<0.001）、中心每年移植量为 9 例或更多（OR，1.31；95%CI，1.17 至 1.47；p<0.001）、机械通气（OR，0.53；95%CI，0.36 至 0.78；p=0.001）和糖尿病（OR，0.67；95%CI，0.57 至 0.78；p<0.001）。
年龄<55 岁、中心每年移植量为 9 例或更多、白种人、缺血时间较短、供体年龄较年轻可提高 OHT 后 10 年的生存率。机械通气和糖尿病降低了这种可能性。这些数据应该为成人 OHT 的长期预后提供有用的指导。
