Prieto David, Correia Pedro, Antunes Pedro, Batista Manuel, Antunes Manuel J
Cardiothoracic Surgery University Hospital, Coimbra, Portugal.
Rev Bras Cir Cardiovasc. 2014 Jul-Sep;29(3):379-87. doi: 10.5935/1678-9741.20140072.
To evaluate immediate and long-term results of cardiac transplantation at two different levels of urgency.
From November 2003 to December 2012, 228 patients underwent cardiac transplantation. Children and patients in cardiogenic shock were excluded from the study. From the final group (n=212), 58 patients (27%) were hospitalized under inotropic support (Group A), while 154 (73%) were awaiting transplantation at home (Group B). Patients in Group A were younger (52.0±11.3 vs. 55.2±10.4 years, P=0.050) and had shorter waiting times (29.4±43.8 vs. 48.8±45.2 days; P=0.006). No difference was found for sex or other comorbidities. Haemoglobin was lower and creatinine higher in Group A. The characteristics of the donors were similar. Follow-up was 4.5±2.7 years.
No differences were found in time of ischemia (89.1±37.0 vs. 91.5±34.5 min, P=0.660) or inotropic support (13.8% vs. 11.0%, P=0.579), neither in the incidence of cellular or humoral rejection and of cardiac allograft vasculopathy. De novo diabetes de novo in the first year was slightly higher in Group A (15.5% vs. 11.7%, P=0.456), and these patients were at increased risk of serious infection (22.4% vs. 12.3%, P=0.068). Hospital mortality was similar (3.4% vs. 4.5%, P=0.724), as well as long-term survival (7.8±0.5 vs. 7.4±0.3 years).
The results obtained in patients hospitalized under inotropic support were similar to those of patients awaiting transplantation at home. Allocation of donors to the first group does not seem to compromise the benefit of transplantation. These results may not be extensible to more critical patients.
评估两种不同紧急程度下心脏移植的近期和长期结果。
2003年11月至2012年12月，228例患者接受了心脏移植。儿童和心源性休克患者被排除在研究之外。在最终组（n = 212）中，58例患者（27%）在接受正性肌力药物支持下住院（A组），而154例（73%）在家等待移植（B组）。A组患者更年轻（52.0±11.3岁 vs. 55.2±10.4岁，P = 0.050），等待时间更短（29.4±43.8天 vs. 48.8±45.2天；P = 0.006）。在性别或其他合并症方面未发现差异。A组患者血红蛋白较低，肌酐较高。供体特征相似。随访时间为4.5±2.7年。
在缺血时间（89.1±37.0分钟 vs. 91.5±34.5分钟，P = 0.660）或正性肌力药物支持（13.8% vs. 11.0%，P = 0.579）方面未发现差异，在细胞或体液排斥反应以及心脏移植血管病变的发生率方面也未发现差异。A组第一年新发糖尿病略高（15.5% vs. 11.7%，P = 0.456），这些患者发生严重感染的风险增加（22.4% vs. 12.3%，P = 0.068）。医院死亡率相似（3.4% vs. 4.5%，P = 0.724），长期生存率也相似（7.8±0.5年 vs. 7.4±0.3年）。
在接受正性肌力药物支持下住院的患者中获得的结果与在家等待移植的患者相似。将供体分配给第一组似乎不会损害移植的益处。这些结果可能不适用于病情更严重的患者。
