Sharma Rajiv, Hawley Carmel, Griffin Raylene, Mundy Julie, Peters Paul, Shah Pallav
Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia.
Interact Cardiovasc Thorac Surg. 2013 Feb;16(2):103-11. doi: 10.1093/icvts/ivs442. Epub 2012 Nov 6.
This study aims to investigate the outcomes of cardiac surgery in patients with abdominal solid organ transplants and to compare them with the case-matched population undergoing cardiac surgery.
Data from all transplant recipients abdominal solid organ transplant (ASOT) N = 36 (30 renal and 6 hepatic) who underwent cardiac surgery in a single centre during the period from January 1997 to December 2010 were collected from hospital transplant registries and the cardiac database. The transplant recipients were case matched (CM) with 104 patients in terms of the variables of age, sex and the type of cardiac surgery. Follow-up data were obtained from medical records and by a set of questionnaire through telephonic interviews.
Follow-up times were 4.5 ± 3.2 and 3.9 ± 3.2 years in the transplant and CM groups, respectively. Follow-up in the transplant group was 100%. There was no 30-day mortality in the transplant group. Thirty-day combined major morbidities were 9% in the matched group vs 11% in the transplant patients (P = 0.6). Median length of stay was 6 days (inter-quartile range, IQR 5.9) for ASOT vs 5 days (IQR 4.6) for CM (P < 0.01). New dialysis was 8.3% in transplant patients compared with 0.96% in the matched population, while infection was 16.66 vs 0.42% in the CM cohort. There was no allograft failure/dysfunction at the time of death or latest follow-up. Late deaths were 8 of 36 (22%) in ASOT vs 6 of 104 (6%) in CM. Infection (63%) was the most frequent major cause of death in transplant patients. One-, 2-, 5- and 10-year survivals for ASOT vs CM were 94, 88, 80, 59 vs 99, 99, 91, 85%, respectively. Multivariate predictors of mortality were increasing age (hazard ratio, HR 1.1, 95% confidence interval, CI 1.04-1.18; P = 0.003) and solid organ transplantation (HR 3.44, CI 1.19-9.98; P = 0.023).
Cardiac surgery can be performed in patients with abdominal solid organ tranpslant recipients with acceptable early morbidity and mortality. However, long-term survival in transplant patients is poor. Infection remains the most common cause of death.
本研究旨在调查腹部实体器官移植患者心脏手术的结果，并将其与接受心脏手术的病例匹配人群进行比较。
收集1997年1月至2010年12月期间在单一中心接受心脏手术的所有腹部实体器官移植（ASOT）受者（N = 36，其中30例为肾移植，6例为肝移植）的数据，这些数据来自医院移植登记处和心脏数据库。根据年龄、性别和心脏手术类型等变量，将移植受者与104例患者进行病例匹配（CM）。通过病历和电话访谈的一组问卷获得随访数据。
移植组和CM组的随访时间分别为4.5±3.2年和3.9±3.2年。移植组的随访率为100%。移植组无30天死亡率。匹配组的30天联合主要发病率为9%，移植患者为11%（P = 0.6）。ASOT的中位住院时间为6天（四分位间距，IQR 5.9），CM为5天（IQR 4.6）（P < 0.01）。移植患者的新透析率为8.3%，匹配人群为0.96%，而CM队列中的感染率分别为16.66%和0.42%。在死亡或最新随访时，没有发生同种异体移植失败/功能障碍。ASOT组36例中有8例（22%）晚期死亡，CM组104例中有6例（6%）。感染（63%）是移植患者最常见的主要死亡原因。ASOT组与CM组的1年、2年、5年和10年生存率分别为94%、88%、80%、59%和99%、99%、91%、85%。死亡率的多变量预测因素是年龄增加（风险比，HR 1.1，95%置信区间，CI 1.04 - 1.18；P = 0.003）和实体器官移植（HR 3.44，CI 1.19 - 9.98；P = 0.023）。
腹部实体器官移植受者患者可以进行心脏手术，早期发病率和死亡率可接受。然而，移植患者的长期生存率较差。感染仍然是最常见的死亡原因。
