Prieto David, Correia Pedro, Baptista Manuel, Antunes Manuel J
Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal.
Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal
Eur J Cardiothorac Surg. 2015 Apr;47(4):672-8. doi: 10.1093/ejcts/ezu257. Epub 2014 Jul 9.
There has been a progressive expansion of heart donor selection criteria, including higher age limit. We analysed the impact of using hearts from older age donors (>50 years).
Between November 2003 and December 2012, 228 heart transplantations were performed. Children and patients requiring ventricular assistance prior to transplantation were excluded. Recipients from 26 donors aged ≥ 50 years (Group A) were compared with those of 136 donors <40 years (Group B). Patient and donor criteria were identical in both groups.
Group A recipients were older than those in Group B (59 ± 11 vs 53 ± 11; P < 0.01), and tended to have more ischaemic cardiomyopathy (50 vs 35%; P = 0.16), be in intensive care (31 vs 27%; P = 0.65) and have longer waiting time (56 ± 49 vs 41 ± 47 days; P = 0.15). There were also significant differences in ischaemic time (65 ± 27 vs 93 ± 35 min; P < 0.01). Thirty-day mortality was similar (3.8 vs 3.7%; P = 0.97). Follow-up was 55 ± 32 months. Actuarial survival at 1, 3 and 5 years was 84 ± 7% for Group A and 90 ± 3, 86 ± 3 and 81 ± 4%, respectively, for Group B (P = 0.85). There were no survival differences between patients younger and older than 60 years, but there was a tendency for decreased survival free from cardiac allograft vasculopathy (CAV) in Group A compared to Group B (at 8 years 65 ± 18 vs 78 ± 7%; P = 0.06).
Parameters of exclusion of donor hearts can and must be adjusted, since the use of selected marginal donors associated with short ischaemic times appears to have no negative impact on morbidity and mortality, more importantly when compared with mortality on the waiting list.
心脏供体选择标准一直在逐步扩大，包括提高年龄上限。我们分析了使用年龄较大供体（>50岁）心脏的影响。
在2003年11月至2012年12月期间，共进行了228例心脏移植手术。排除了儿童及移植前需要心室辅助的患者。将26例年龄≥50岁供体的受者（A组）与136例年龄<40岁供体的受者（B组）进行比较。两组的患者和供体标准相同。
A组受者比B组受者年龄更大（59±11岁 vs 53±11岁；P<0.01），且缺血性心肌病发生率更高（50% vs 35%；P = 0.16），入住重症监护病房的比例更高（31% vs 27%；P = 0.65），等待时间更长（56±49天 vs 41±47天；P = 0.15）。缺血时间也存在显著差异（65±27分钟 vs 93±35分钟；P<0.01）。30天死亡率相似（3.8% vs 3.7%；P = 0.97）。随访时间为55±32个月。A组1年、3年和5年的精算生存率分别为84±7%，B组分别为90±3%、86±3%和81±4%（P = 0.85）。60岁及以上和60岁以下患者的生存率无差异，但与B组相比，A组发生心脏移植血管病变（CAV）后无生存差异的趋势（8年时为65±18% vs 78±7%；P = 0.06）。
必须调整供体心脏的排除参数，因为使用缺血时间短的选定边缘供体似乎对发病率和死亡率没有负面影响，更重要的是与等待名单上的死亡率相比。
