Tallaj José A, Pamboukian Salpy V, George James F, Kirklin James K, Brown Robert N, McGiffin David C, Acharya Deepak, Loyaga-Rendon Renzo, Melby Spencer J, Bourge Robert C, Naftel David C
Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine, Birmingham VA Medical Center, Birmingham, Alabama.
Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
J Heart Lung Transplant. 2014 Dec;33(12):1304-11. doi: 10.1016/j.healun.2014.08.014. Epub 2014 Aug 28.
The Cardiac Transplant Research Database (CTRD) collected data from 26 U.S. institutions from January 1, 1990 to December 31, 2008 providing the opportunity for construction of a comprehensive multivariable model of risk for death after transplantation. We analyzed risk factors for death over 19 years of experience to determine how risk profiles have changed over time and how they interact with age.
A multivariable parametric hazard model for death was created for 7,015 patients entered into the CTRD. Variables collected over 19 years of experience were examined as potential risk factors and tested for interaction with date of transplantation to determine if their relative risk (RR) changed over time.
The hazard for death post-transplant occurred in 2 phases: an early phase of acute risk lasting <1 year, and a late phase of relatively low, gradually increasing risk (<0.1 event/year). In the early phase, predictive models showed that ventricular assist device (VAD) at the time of transplant did not increase the RR of death for recipient transplant at 30 years of age, but the RR of death was increased by 60% (p = 0.04) at 60 years of age. Of the late-phase variables found to be risk factors, the RR of age, date of transplant and pulmonary vascular resistance changed with respect to transplant year. The overall risk of death dropped importantly over the study period, but the RR of all other variables remained unchanged. RR was 2.6 (p < 0.0001) for 25-year-old African-American (AA) versus non-AA recipients and 1.6 for 60-year-old AA recipients (p = 0.02).
Over 19 years, the baseline risk of death has decreased, but the specific risk factors and the magnitudes of their RR have remained unchanged. Therefore, despite advances in clinical management and improvement in overall survival, the risk profile for death after cardiac transplantation is similar to that in 1990.
心脏移植研究数据库（CTRD）收集了1990年1月1日至2008年12月31日期间来自美国26家机构的数据，为构建移植后死亡风险的综合多变量模型提供了机会。我们分析了19年经验中的死亡风险因素，以确定风险概况如何随时间变化以及它们如何与年龄相互作用。
为CTRD纳入的7015名患者创建了死亡的多变量参数风险模型。检查了19年经验中收集的变量作为潜在风险因素，并测试了与移植日期的相互作用，以确定其相对风险（RR）是否随时间变化。
移植后死亡风险分为两个阶段：急性风险的早期阶段持续时间小于1年，以及相对较低、逐渐增加风险的晚期阶段（每年<0.1事件）。在早期阶段，预测模型显示，30岁接受移植的患者在移植时使用心室辅助装置（VAD）不会增加死亡RR，但60岁时死亡RR增加60%（p = 0.04）。在被发现为风险因素的晚期变量中，年龄、移植日期和肺血管阻力的RR随移植年份而变化。在研究期间，总体死亡风险显著下降，但所有其他变量的RR保持不变。25岁非裔美国人（AA）与非AA受体的RR为2.6（p < 0.0001），60岁AA受体的RR为1.6（p = 0.02）。
在19年期间，死亡的基线风险有所下降，但具体风险因素及其RR的大小保持不变。因此，尽管临床管理取得进展且总体生存率有所提高，但心脏移植后死亡的风险概况与1990年相似。
