Atik Fernando Antibas, Couto Carolina Fatima, Tirado Freddy Ponce, Moraes Camila Scatolin, Chaves Renato Bueno, Vieira Nubia W, Reis João Gabbardo
Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil.
Rev Bras Cir Cardiovasc. 2014 Jul-Sep;29(3):344-9. doi: 10.5935/1678-9741.20140046.
Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list.
Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 26 (36%) and heart recovery occurred in 5 (7%). Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73%) transplants were performed with local donors and 11 (27%) with long-distance donors (mean distance=792 km±397).
Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001). Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23) and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank) were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05) with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18). There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09).
Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time.
评估在心脏移植项目中增加远距离心脏获取以及心脏移植受者等待名单的状况。
2006年9月至2012年10月期间，72例患者被列入心脏移植受者名单。41例（57%）患者接受了心脏移植，26例（36%）在等待名单上死亡，5例（7%）心脏恢复。最初，所有移植均使用本地供体。2011年2月开始进行跨州远距离心脏获取。30例（73%）移植使用本地供体，11例（27%）使用远距离供体（平均距离 = 792公里±397）。
接受跨州心脏获取的患者缺血时间更长（212分钟±32 vs 90分钟±18；P<0.0001）。原发性移植物功能障碍（远距离9.1% vs 本地26.7%；P = 0.23）以及1个月和12个月的精算生存率（远距离90.1%和90.1% vs 本地90%和86.2%；P = 0.65对数秩）在各组间相似。移植中心的手术量有显著增加（64.4% vs 40.7%，P = 0.05），等待名单时间有缩短趋势（中位数1.5个月 vs 2.4个月，P = 0.18）。等待名单死亡率有降低趋势（28.9% vs 48.2%，P = 0.09）。
纳入远距离心脏获取，尽管与更长的缺血时间相关，但并不会增加心脏移植后的发病率和死亡率。它扩大了可用供体库，并且可能降低等待名单上受者的死亡率以及等待时间。
