Eskandary Farsad Alexander, Kohl Maria, Dunkler Daniela, Aliabadi Arezu, Grömmer Martina, Schiferer Arno, Gökler Johannes, Wieselthaler Georg, Laufer Günther, Zuckermann Andreas
Department of Cardiac Surgery.
Center for Medical Statistics, Informatics and Intelligent Systems.
J Heart Lung Transplant. 2014 Jun;33(6):629-35. doi: 10.1016/j.healun.2014.02.005. Epub 2014 Feb 12.
The proportion of older donors and recipients is constantly rising in heart transplantation (HTX). The impact of age on different outcomes after HTX has been studied; however, effects of interaction between donor and recipient age remain elusive.
This retrospective cohort study comprised 1,190 patients who underwent HTX between 1984 and 2011 at the Medical University Vienna. Multivariable models consisted of a basic set that included donor age, recipient age, and transplant eras and were adjusted for 2 sets of 6 possible confounders and 3 mediator variables. Cox models were used to estimate the risk of death. To search for age-related effects on the development of cardiac allograft vasculopathy (CAV), we applied cause-specific Cox models and proportional sub-distribution hazard models for competing risk data.
Survival was 80%, 77%, 69%, and 56% after 1, 2, 5, and 10 years, respectively. Donor age (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.0-1.2), recipient age (HR, 1.1; 95% CI, 1.0-1.2), admission from intensive care unit to HTX (HR, 1.5; 95% CI, 1.2-1.9), and diabetes (HR, 1.4; 95% CI, 1.1-1.7) were identified as significant independent risk factors for death. Significant risk factors for CAV were donor age (HR, 1.4; 95% CI, 1.3-1.5) and male recipient sex (HR, 1.5; 95% CI, 1.0-2.2). Recipient age was inversely associated with initiation of CAV (HR, 0.8; 95% CI, 0.8-1.0). Analysis of the interaction between donor and recipient age was not significant for death (p = 0.8) or CAV (p = 0.6).
We found no interaction between donor and recipient age negatively affecting mortality and CAV. The identified independent risk factors may have implications for allocation strategies in elderly recipients.
在心脏移植（HTX）中，老年供体和受体的比例在不断上升。年龄对HTX后不同结局的影响已得到研究；然而，供体和受体年龄之间相互作用的影响仍不明确。
这项回顾性队列研究纳入了1984年至2011年在维也纳医科大学接受HTX的1190例患者。多变量模型包括一个基本组，其中包含供体年龄、受体年龄和移植时代，并针对两组共6个可能的混杂因素和3个中介变量进行了调整。采用Cox模型估计死亡风险。为了研究年龄对心脏移植血管病变（CAV）发生发展的影响，我们对竞争风险数据应用了特定病因Cox模型和比例亚分布风险模型。
1年、2年、5年和10年后的生存率分别为80%、77%、69%和56%。供体年龄（风险比[HR]为1.1；95%置信区间[CI]为1.0 - 1.2）、受体年龄（HR为1.1；95%CI为1.0 - 1.2）、从重症监护病房转入HTX（HR为1.5；95%CI为1.2 - 1.9）以及糖尿病（HR为1.4；95%CI为1.1 - 1.7）被确定为死亡的显著独立危险因素。CAV的显著危险因素为供体年龄（HR为1.4；95%CI为1.3 - 1.5）和男性受体性别（HR为1.5；95%CI为1.0 - 2.2）。受体年龄与CAV的起始呈负相关（HR为0.8；95%CI为0.8 - 1.0）。供体和受体年龄之间的相互作用分析对死亡（p = 0.8）或CAV（p = 0.6）而言无显著意义。
我们发现供体和受体年龄之间不存在对死亡率和CAV产生负面影响的相互作用。所确定的独立危险因素可能对老年受体的分配策略具有启示意义。
