Taghavi Sharven, Jayarajan Senthil N, Komaroff Eugene, Shiose Akira, Schwartz Daniel, Hamad Eman, Alvarez Rene, Wheatley Grayson, Guy T Sloane, Toyoda Yoshiya
1 Department of Surgery, Temple University School of Medicine, Philadelphia, PA. 2 Department of Public Health, Temple University, Philadelphia, PA. 3 Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA. 4 Section of Cardiology, Temple University School of Medicine, Philadelphia, PA.
Transplantation. 2015 Jun;99(6):1226-30. doi: 10.1097/TP.0000000000000514.
Although orthotopic heart transplantation (OHT) remains the preferred treatment for end-stage heart failure, there continues to be a critical shortage of organ donors. The goal of this study is to examine outcomes after orthotopic OHT using heavy drinking donors (HDDs) in a large, national database.
The United Network for Organ Sharing database was examined for all primary, adult OHT carried out from 2005 to 2012.
There were 14,928 total OHT performed during the study period with 2,274 (15.2%) using HDD. Recipients of HDD were older (53.4 vs. 51.9 years, P < 0.001), more likely men (80.7 vs 74.4%, P < 0.001), less likely sex mismatched (21.5 vs 27.5%, P < 0.001), more likely race mismatched (57.4 vs 52.4%, P < 0.001), and had less total HLA mismatches (4.55 vs 4.65, P < 0.001). The HDD were older (37.0 vs 30.5 years, P < 0.001), more likely men (82.2 vs 69.9%, P < 0.001), and more likely to have heavy cigarette use (38.1 vs 13.2%, P < 0.001). Length of stay was not different (20.3 vs 19.7 days, P = 0.02). On multivariate analysis, use of HDD was not associated with mortality at 30 days (hazards ratio [HR], 1.12; 95% confidence interval [95% CI], 0.90-1.39; P = 0.30), 1 year (HR, 0.96; 95% CI, 0.83-1.11; P = 0.56), and at 5 years (HR, 1.02; 95% CI, 0.91-1.13; P = 0.79). Variables associated with mortality at 5 years included increasing donor age, prolonged ischemic time, worsening recipient creatinine, recipient black race, sex mismatch, and extracorporeal membrane oxygenation or mechanical ventilation as a bridge to transplantation.
Heart transplantation can be performed using carefully selected HDDs with good outcomes.
尽管原位心脏移植（OHT）仍然是终末期心力衰竭的首选治疗方法，但器官捐献者仍然严重短缺。本研究的目的是在一个大型的全国性数据库中，研究使用大量饮酒的捐献者（HDD）进行原位OHT后的结果。
对器官共享联合网络数据库中2005年至2012年进行的所有原发性成人OHT进行检查。
在研究期间共进行了14928例OHT，其中2274例（15.2%）使用了HDD。HDD的接受者年龄更大（53.4岁对51.9岁，P<0.001），男性比例更高（80.7%对74.4%，P<0.001），性别不匹配的可能性更小（21.5%对27.5%，P<0.001），种族不匹配的可能性更大（57.4%对52.4%，P<0.001），且HLA总错配数更少（4.55对4.65，P<0.001）。HDD年龄更大（37.0岁对30.5岁，P<0.001），男性比例更高（82.2%对69.9%，P<0.001），且大量吸烟的可能性更大（38.1%对13.2%，P<0.001）。住院时间无差异（20.3天对19.7天，P = 0.02）。多因素分析显示，使用HDD与30天死亡率（风险比[HR]，1.12；95%置信区间[95%CI]，0.90 - 1.39；P = 0.30）、1年死亡率（HR，0.96；95%CI，0.83 - 1.11；P = 0.56）和5年死亡率（HR，1.02；95%CI，0.91 - 1.13；P = 0.79）均无关。与5年死亡率相关的变量包括捐献者年龄增加、缺血时间延长、接受者肌酐恶化、接受者为黑人种族、性别不匹配以及作为移植过渡的体外膜肺氧合或机械通气。
使用精心挑选的HDD进行心脏移植可获得良好的结果。
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