Division of Cardiac Surgery, Department of Surgery, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Ann Thorac Surg. 2014 May;97(5):1636-42. doi: 10.1016/j.athoracsur.2013.12.048. Epub 2014 Mar 20.
This study evaluated changes in physical functional performance after orthotopic heart transplantation (OHT) with particular attention to the impact of recipient age on functional outcomes.
Retrospective review of all first-time, single-organ adult OHTs in the United States between 2005 and 2010. Patients were primarily stratified by age. The validated Karnofsky performance scale, which ranges from 0 (death) to 100 (fully independent with no evidence of disease and no complaints), was used to measure functional status.
A total of 10,049 OHT recipients were identified, with 1,431 (14%) aged 65 years or greater. Mean Karnofsky score prior to OHT was comparable between cohorts (younger: 50.7±25.2 versus older: 50.1±25.0; p=0.38). At a median follow-up of 2.1 years (interquartile range 0.7 to 3.3 years), 64% of OHT recipients had improved functional performance. The mean improvement in Karnofsky score was similar between younger and older patients (19.6±42.0 vs 17.5±41.8; p=0.10). Twenty percent of younger patients were functionally independent prior to OHT, with 67% being functionally independent at last follow-up (p<0.001). Similarly, in the older cohort, 20% were functionally independent prior to OHT, with 66% being functionally independent at last follow-up (p<0.001). Multivariable analysis adjusting for potential confounders confirmed that age, both as a continuous and categoric variable, did not impact odds of functional improvement after OHT. Subanalysis using 70 years as the age cutoff produced similar results.
In the modern era, OHT is associated with improvements in functional performance in most recipients, and this beneficial effect is preserved across the age spectrum. These data provide a benchmark for functional outcomes after OHT and may have important implications in organ allocation.
本研究评估了同种异体心脏移植（OHT）后患者身体机能表现的变化，并特别关注受者年龄对功能结局的影响。
回顾性分析了 2005 年至 2010 年期间美国首次接受单器官成人 OHT 的所有患者。患者主要按年龄分层。采用经过验证的卡诺夫斯基表现量表（Karnofsky performance scale）来衡量功能状态，该量表的范围为 0（死亡）至 100（完全独立，无疾病证据，无抱怨）。
共确定了 10049 例 OHT 受者，其中 1431 例（14%）年龄在 65 岁或以上。OHT 前的平均卡诺夫斯基评分在两组间无差异（年轻组：50.7±25.2；年长组：50.1±25.0；p=0.38）。中位随访时间为 2.1 年（四分位距 0.7 至 3.3 年），64%的 OHT 受者的身体机能表现得到改善。年轻组和年长组的卡诺夫斯基评分平均改善程度相似（19.6±42.0 与 17.5±41.8；p=0.10）。OHT 前，20%的年轻患者为功能独立，最后一次随访时 67%为功能独立（p<0.001）。同样，在年长组中，OHT 前 20%的患者为功能独立，最后一次随访时 66%的患者为功能独立（p<0.001）。调整潜在混杂因素的多变量分析证实，年龄（连续变量和分类变量）均不会影响 OHT 后功能改善的几率。使用 70 岁作为年龄切点的亚组分析得出了类似的结果。
在现代，OHT 与大多数受者的身体机能表现改善相关，且这种有益作用在整个年龄范围内得以保留。这些数据为 OHT 后的功能结局提供了基准，并可能对器官分配具有重要意义。
