Bombardini Tonino, Arpesella Giorgio, Maccherini Massimo, Procaccio Francesco, Potena Luciano, Bernazzali Sonia, Leone Ornella, Picano Eugenio
Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy.
Cardiovasc Ultrasound. 2014 Jun 16;12:20. doi: 10.1186/1476-7120-12-20.
Heart transplantation is limited by severe donor organ shortage. Regardless of the changes made in the acceptance of marginal donors, any such mechanism cannot be considered successful unless recipient graft survival rates remain acceptable. A stress echo-driven selection of donors has proven successful in older donors with normal left ventricular resting function and in standard donors with reversible resting left ventricular dysfunction acutely improving during stress, or slowly improving (over hours) during intensive hormonal treatment. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected with new echocardiographic techniques over standard criteria.
We enrolled 43 recipients of marginal donor hearts: age > 55 years, or < 55 years but with concomitant risk factors, n = 32; acutely improving during stress, n = 3; or slowly improving during hormonal treatment, n = 8. At follow-up (median, 30 months; interquartile range, 21-52 months), 37 of the recipients were still alive. One-year survival was 93%.
The strict use of new stress-echocardiographic techniques over standard criteria of marginal donor management, together with comprehensive monitoring of the donor, has the potential to substantially increase the number of donor hearts without adverse effects on recipient medium-term outcome.
心脏移植受到供体器官严重短缺的限制。无论在接受边缘供体方面有何变化，除非受体移植物存活率仍可接受，否则任何此类机制都不能被视为成功。对于左心室静息功能正常的老年供体以及在负荷试验中急性改善或在强化激素治疗期间（数小时内）缓慢改善的具有可逆性静息左心室功能障碍的标准供体，通过负荷超声心动图驱动的供体选择已被证明是成功的。本研究的目的是评估采用新的超声心动图技术而非标准标准选择的边缘供体心脏受体的中期结局。
我们纳入了43例边缘供体心脏受体：年龄>55岁，或年龄<55岁但伴有危险因素，n = 32；在负荷试验中急性改善，n = 3；或在激素治疗期间缓慢改善，n = 8。在随访（中位数为30个月；四分位间距为21 - 52个月）时，37例受体仍存活。1年生存率为93%。
相对于边缘供体管理的标准标准，严格使用新的负荷超声心动图技术，并对供体进行全面监测，有可能大幅增加供体心脏数量，且对受体中期结局无不良影响。
