Conway Jennifer, Chrisant Maryanne R K, West Lori J, Ameduri Rebecca K, Alejos Juan C, Lamour Jacqueline M, Das Bibhuti, Gilbert Deborah, Tresler Margaret, Naftel David C, Miyamoto Shelley D
Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Transplant. 2013 Nov;17(7):653-60. doi: 10.1111/petr.12130. Epub 2013 Aug 6.
HTx in neonates is mainstay therapy for those with severe cardiomyopathies and congenital heart disease. Fetal listing for HTx has been proposed as a way to increase the potential window for a donor with outcomes predicted to be similar to the neonatal population. Data from the PHTS, a prospective multicenter study, were used to examine the outcomes of fetuses listed between 1993 and 2009. Four thousand three hundred and sixty-five children were listed for HTx during this period. Fetuses comprised 1% and neonates 19.8% of listed patients. In those patients listed as fetus and transplanted, the median wait time from listing to HTx was 55 days (range 4-255), with a median of 25 days (range 0-233) after birth. By six months post-listing, a higher proportion of fetal listed patients had undergone HTx with a lower waitlist mortality when compared with neonate. There was no significant difference in survival following HTx between the two group (p = 0.4). While the results of this study may be less applicable to current practice due to changes in referrals for fetal listing, they do indicate that fetal listing can be a reasonable option. These results are of particular interest at the present time given the ongoing public discourse on the proposed elimination of fetal listing within UNOS.
对于患有严重心肌病和先天性心脏病的新生儿，心脏移植是主要治疗方法。有人提出将胎儿列入心脏移植名单，以此来扩大潜在供体的范围，预计其结果与新生儿群体相似。一项前瞻性多中心研究——儿科心脏移植研究（PHTS）的数据，被用于研究1993年至2009年间列入名单的胎儿的情况。在此期间，有4365名儿童被列入心脏移植名单。胎儿占名单上患者的1%，新生儿占19.8%。在那些被列为胎儿并接受移植的患者中，从列入名单到心脏移植的中位等待时间为55天（范围4 - 255天），出生后的中位等待时间为25天（范围0 - 233天）。与新生儿相比，在列入名单后六个月内，更高比例的列入胎儿名单的患者接受了心脏移植，且等待名单上的死亡率更低。两组患者心脏移植后的生存率无显著差异（p = 0.4）。尽管由于胎儿列入名单的转诊情况发生变化，本研究结果可能不太适用于当前实践，但它们确实表明将胎儿列入名单可能是一个合理的选择。鉴于目前公众正在讨论联合国器官共享网络（UNOS）提议取消胎儿列入名单的问题，这些结果目前格外引人关注。
