机械桥接心脏移植失败患者进行再次移植是否是一种有效的治疗方法？对 United Network of Organ Sharing 数据库的分析。
Is mechanically bridging patients with a failing cardiac graft to retransplantation an effective therapy? Analysis of the United Network of Organ Sharing database.
机构信息
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
出版信息
J Heart Lung Transplant. 2012 Nov;31(11):1192-8. doi: 10.1016/j.healun.2012.07.004. Epub 2012 Aug 17.
BACKGROUND
The results of bridging patients with cardiac allograft failure to retransplantation (ReTx) with mechanical circulatory support (MCS) have not been well studied. The United Network of Organ Sharing (UNOS) database was used to analyze outcomes of patients successfully bridged with MCS to cardiac ReTx.
METHODS
Of 1,690 cardiac ReTx identified in the UNOS database from October 1987 to July 2011, 149 (8.8%) were bridged to ReTx with MCS.
RESULTS
Patients bridged to ReTx with MCS had a poorer survival than patients not bridged (p < 0.0001). ReTx after ventricular assist device (VAD) support had better survival than ReTx after extracorporeal membrane oxygenation (ECMO; half-life, 3.9 years vs 61 days, p = 0.026). For patients bridged to ReTx, graft survival was 40% for ReTx within 1 year of primary Tx vs 64% (p = 0.003). When ReTx was performed 1 year after cardiac Tx, survival was similar in patients bridged with a VAD and those not bridged (mean, 7.5 vs 8.7 years; p = 0.8). Survival for patients bridged to ReTx with ECMO was consistently worse (p ≤ 0.05) in all analyses. The 1-year survival of ReTx after VAD performed in 2003 to 2011 (67%) was better than in the earlier era of 1987 to 2002 (37%, p = 0.005).
CONCLUSIONS
Bridging patients to ReTx with ECMO at any time is not advisable. Bridging patients with MCS to ReTx within 1 year of primary cardiac Tx is not advisable. Survival after ReTx for patients bridged by VAD has improved considerably over time. Patients who survive the first year after cardiac Tx can be bridged by VAD to ReTx with an expectation that outcomes can be similar to ReTx patients who did not require MCS.
背景
使用机械循环支持（MCS）桥接心脏移植失败患者接受再次移植（ReTx）的结果尚未得到很好的研究。本研究使用美国器官共享网络（UNOS）数据库分析了使用 MCS 成功桥接心脏 ReTx 的患者的结局。
方法
在 1987 年 10 月至 2011 年 7 月 UNOS 数据库中确定的 1690 例心脏 ReTx 中，有 149 例（8.8%）使用 MCS 桥接至 ReTx。
结果
与未桥接的患者相比，使用 MCS 桥接至 ReTx 的患者存活率较差（p < 0.0001）。心室辅助装置（VAD）支持后再移植的患者存活率优于体外膜氧合（ECMO；半衰期分别为 3.9 年和 61 天，p = 0.026）。对于桥接至 ReTx 的患者，初次 Tx 后 1 年内进行 ReTx 的患者移植物存活率为 40%，而初次 Tx 后 1 年进行 ReTx 的患者为 64%（p = 0.003）。心脏 Tx 后 1 年进行 ReTx 时，VAD 桥接和未桥接患者的存活率相似（平均分别为 7.5 年和 8.7 年；p = 0.8）。在所有分析中，使用 ECMO 桥接至 ReTx 的患者的存活率均较差（p ≤ 0.05）。2003 年至 2011 年期间进行的 VAD 后 1 年 ReTx 的存活率（67%）高于 1987 年至 2002 年的早期时期（37%，p = 0.005）。
结论
在任何时候使用 ECMO 桥接患者进行 ReTx 均不可取。初次心脏 Tx 后 1 年内使用 MCS 桥接患者进行 ReTx 不可取。随着时间的推移，通过 VAD 桥接接受 ReTx 的患者的存活率有了显著提高。心脏 Tx 后存活 1 年的患者可以通过 VAD 桥接至 ReTx，预期结果可以与无需 MCS 的 ReTx 患者相似。
Zotero 插件