Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
J Thorac Cardiovasc Surg. 2012 Feb;143(2):468-74. doi: 10.1016/j.jtcvs.2011.10.036.
The aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT).
A review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis.
A total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5%) were 5-year survivors, 1580 (29.6%) had died within 5 years of OHT and were considered controls, and 258 (4.8%) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-1.00; P = .03), lower creatinine (OR, 0.92; 95% CI, 0.87-0.98; P = .01), white race (OR, 1.23; 95% CI, 1.02-1.49; P = .03), shorter ischemic time (OR, 0.93; 95% CI, 0.87-0.99; P = .02), and younger donor age (OR, 0.99; 95% CI, 0.99-1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95% CI, 0.33-0.71; P < .001), hypertension (OR, 0.79; 95% CI, 0.69-0.91; P = .001), and diabetes (OR, 0.79; 95% CI, 0.67-0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6%). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95% CI, 0.50-0.81; P < .001).
In the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.
本研究旨在确定行原位心脏移植（OHT）的老年患者 5 年生存率的预测因素。
对 1995 年至 2004 年间接受 OHT 的年龄在 60 岁或以上的器官共享联合网络数据库进行了回顾性分析。将 5 年幸存者和 OHT 后 5 年内死亡的患者之间的变量进行了比较。使用单因素分析中与 5 年生存率显著相关的协变量构建了多变量逻辑回归模型。
在研究期间，共有 5330 名老年患者接受了 OHT。其中 3492 名（65.5%）患者为 5 年幸存者，1580 名（29.6%）患者在 OHT 后 5 年内死亡作为对照组，258 名（4.8%）患者失访。改善 5 年生存率的预测因素包括年龄较小（比值比 [OR]，0.97；95%置信区间 [CI]，0.95-1.00；P =.03）、肌酐较低（OR，0.92；95% CI，0.87-0.98；P =.01）、白种人（OR，1.23；95% CI，1.02-1.49；P =.03）、缺血时间较短（OR，0.93；95% CI，0.87-0.99；P =.02）和供体年龄较小（OR，0.99；95% CI，0.99-1.00；P =.03）。以下因素显著降低了存活 5 年的几率：机械通气（OR，0.48；95% CI，0.33-0.71；P <.001）、高血压（OR，0.79；95% CI，0.69-0.91；P =.001）和糖尿病（OR，0.79；95% CI，0.67-0.92；P =.003）。只有 2538 名患者（49.6%）有心室辅助装置的数据。当加入多变量模型时，使用心室辅助装置显著降低了 OHT 后 5 年的生存几率（OR，0.63；95% CI，0.50-0.81；P <.001）。
在这项对 5000 多名老年 OHT 患者的研究中，年轻的受者年龄、白种人、较低的肌酐、年轻的供者年龄和较短的缺血时间与改善 5 年生存率相关。相比之下，使用心室辅助装置进行桥接、机械通气、高血压和糖尿病显著降低了 5 年生存率的几率。这些发现可能对这一高风险患者群体的预后评估有用。
