Duke University Medical Center, and the Duke Clinical Research Institute, Durham, NC.
Circ Heart Fail. 2013 Nov;6(6):1230-8. doi: 10.1161/CIRCHEARTFAILURE.113.000296. Epub 2013 Oct 2.
Extended criteria cardiac transplant (ECCT) programs expand the transplant pool by matching donors and recipients typically excluded from the transplant process because of age or comorbidity. There is a paucity of data examining long-term outcomes with this strategy.
Between January 2000 and December 2009, adult patients undergoing isolated heart transplant were prospectively classified as ECCT based on prespecified criteria. Baseline characteristics and outcomes were compared between ECCT and standard criteria cardiac transplant recipients. Two Cox proportional hazards models were developed. The first to identify clinical variables contributing to survival between the 2 groups, and the second to determine the additional risk associated with assignment to ECCT. Among the 454 patients who underwent heart transplant, 84 (18.5%) were ECCT. Compared with the patients who underwent standard criteria cardiac transplant, ECCT patients were older (median, 66.6 years versus 53.2 years; P<0.001), with higher frequency of diabetes mellitus (46.4% versus 24.6%; P<0.001) and chronic kidney disease (median estimated glomerular filtration rate, 55 versus 61.6 mL/min; P=0.001). After adjustment for baseline characteristics, standard criteria cardiac transplant survival was higher than ECCT at 1 (89% versus 86%; P=0.18) and 5 (77% versus 66%; P=0.035) years. In a multivariate model that included listing criteria, creatinine (hazard ratio, 1.05 per 0.1 mg/dL; 95% confidence interval, 1.02-1.09; P=0.001) was a significant predictor of post-transplant mortality.
ECCT is an acceptable alternative for advanced heart failure therapy in select patients. Age and renal dysfunction are important determinants of long-term survival and post-transplant morbidity.
通过匹配通常因年龄或合并症而被排除在移植过程之外的供体和受者，扩大标准心脏移植（ECCT）项目扩大了移植池。 关于这种策略的长期结果数据很少。
2000 年 1 月至 2009 年 12 月，根据预设标准，前瞻性地将接受单纯心脏移植的成年患者分为 ECCT。比较 ECCT 和标准标准心脏移植受者的基线特征和结局。建立了两个 Cox 比例风险模型。第一个确定两组之间生存的临床变量，第二个确定分配给 ECCT 的额外风险。在接受心脏移植的 454 名患者中，84 名（18.5%）为 ECCT。与接受标准标准心脏移植的患者相比，ECCT 患者年龄更大（中位数，66.6 岁比 53.2 岁；P<0.001），糖尿病（46.4%比 24.6%；P<0.001）和慢性肾脏疾病（中位数估计肾小球滤过率，55 比 61.6 mL/min；P=0.001）的频率更高。在调整基线特征后，标准标准心脏移植的生存率在 1 年（89%比 86%；P=0.18）和 5 年（77%比 66%；P=0.035）时均高于 ECCT。在包括列入标准的多变量模型中，肌酐（危险比，每 0.1mg/dL 增加 1.05；95%置信区间，1.02-1.09；P=0.001）是移植后死亡的重要预测因素。
ECCT 是选择性患者晚期心力衰竭治疗的一种可行替代方法。年龄和肾功能不全是长期生存和移植后发病率的重要决定因素。
