Department of Surgery, Temple University Hospital, Philadelphia, Pa, USA.
J Thorac Cardiovasc Surg. 2013 Aug;146(2):442-7. doi: 10.1016/j.jtcvs.2013.02.047. Epub 2013 Mar 13.
Cardiac transplantation (OHT) using diabetic donors (DDs) is thought to adversely influence survival. We attempt to determine if adult OHT can be safely performed using selected DDs.
The United Network for Organ Sharing (UNOS) database was examined for adult OHT from 2000 to 2010.
Of the 20,348 patients undergoing OHT, 496 (2.4%) were with DDs. DDs were older (39.6 vs 31.3 years; P < .001), more likely female (41.5% vs 28.3%; P < .001), and had a higher body mass index (BMI) (29.9 vs 26.4; P < .001). Recipients of DD hearts were older (53.4 vs 51.8; P = .004) and more likely to have diabetes (18.9% vs 14.9%; P = .024). The 2 groups were evenly matched with regard to recipient male gender (78.0% vs 76.1%; P = .312), ischemic time (3.3 vs 3.2 hours; P = .191), human leukocyte antigen mismatches (4.7 vs 4.6; P = .483), and requirement of extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (0.8% vs 0.5%; P = .382). Median survival was similar (3799 vs 3798 days; P = .172). On multivariate analysis, DD was not associated with mortality (hazard ratio [HR], 1.155; 95% confidence interval [CI], 0.943-1.415; P = .164). As previously demonstrated, donor age, decreasing donor BMI, ischemic time, recipient creatinine, recipient black race, recipient diabetes, race mismatch, and mechanical ventilation or ECMO as a bridge to transplant were associated with mortality. On multivariate analysis of subgroups, neither insulin-dependent diabetes (1.173; 95% CI, 0.884-1.444; P = .268) nor duration of diabetes for more than 5 years (HR, 1.239; 95% CI, 0.914-1.016; P = .167) was associated with mortality.
OHT can be safely performed using selected DDs. Consensus criteria for acceptable cardiac donors can likely be revised to include selected DDs.
使用糖尿病供体（DD）进行心脏移植（OHT）被认为会对生存率产生不利影响。我们试图确定使用选定的 DD 是否可以安全地进行成人 OHT。
检查了 2000 年至 2010 年期间，美国器官共享联合网络（UNOS）数据库中成人 OHT 的数据。
在 20348 例接受 OHT 的患者中，有 496 例（2.4%）使用了 DD。DD 年龄更大（39.6 岁 vs. 31.3 岁；P <.001），女性比例更高（41.5% vs. 28.3%；P <.001），体重指数（BMI）更高（29.9 公斤/平方米 vs. 26.4 公斤/平方米；P <.001）。接受 DD 心脏的患者年龄更大（53.4 岁 vs. 51.8 岁；P =.004），更有可能患有糖尿病（18.9% vs. 14.9%；P =.024）。两组在接受者的性别（78.0% vs. 76.1%；P =.312）、缺血时间（3.3 小时 vs. 3.2 小时；P =.191）、人类白细胞抗原匹配数（4.7 对 4.6；P =.483）和需要体外膜氧合（ECMO）作为移植桥接（0.8% vs. 0.5%；P =.382）方面相当。中位生存时间相似（3799 天 vs. 3798 天；P =.172）。多变量分析显示，DD 与死亡率无关（风险比[HR]，1.155；95%置信区间[CI]，0.943-1.415；P =.164）。正如之前所证明的，供体年龄、供体 BMI 降低、缺血时间、受者肌酐、受者黑人种族、受者糖尿病、种族不匹配以及机械通气或 ECMO 作为移植桥接与死亡率相关。在亚组的多变量分析中，胰岛素依赖型糖尿病（HR，1.173；95%CI，0.884-1.444；P =.268）或糖尿病持续时间超过 5 年（HR，1.239；95%CI，0.914-1.016；P =.167）均与死亡率无关。
使用选定的 DD 可以安全地进行 OHT。心脏供体的可接受标准可能可以修订为包括选定的 DD。
