预测心脏移植受者短期死亡率的心脏供体风险因素：器官共享联合网络数据库分析
Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database.
作者信息
Sorabella R A, Guglielmetti L, Kantor A, Castillero E, Takayama H, Schulze P C, Mancini D, Naka Y, George I
机构信息
Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
出版信息
Transplant Proc. 2015 Dec;47(10):2944-51. doi: 10.1016/j.transproceed.2015.10.021.
INTRODUCTION
To address the shortage of donor hearts for transplantation, there is significant interest in liberalizing donor acceptance criteria. Therefore, the aim of this study was to evaluate cardiac donor characteristics from the United Network for Organ Sharing (UNOS) database to determine their impact on posttransplantation recipient outcomes.
METHODS
Adult (≥18 years) patients undergoing heart transplantation from July 1, 2004, to December 31, 2012, in the UNOS Standard Transplant Analysis and Research (STAR) database were reviewed. Patients were stratified by 1-year posttransplantation status; survivors (group S, n = 13,643) and patients who died or underwent cardiac retransplantation at 1-year follow-up (group NS/R = 1785). Thirty-three specific donor variables were collected for each recipient, and independent donor predictors of recipient death or retransplantation at 1 year were determined using multivariable logistic regression analysis.
RESULTS
Overall 1-year survival for the entire cohort was 88.4%. Mean donor age was 31.5 ± 11.9 years, and 72% were male. On multivariable logistic regression analysis, donor age >40 years (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.27 to 1.64), graft ischemic time >3 hours (OR 1.32, 1.16 to 1.51), and the use of cardioplegia (OR 1.17, 1.01 to 1.35) or Celsior (OR 1.21, 1.06 to 1.38) preservative solution were significant predictors of recipient death or retransplantation at 1 year posttransplantation. Male donor sex (OR 0.83, 0.74 to 0.93) and the use of antihypertensive agents (OR 0.88, 0.77 to 1.00) or insulin (OR 0.84, 0.76 to 0.94) were protective from adverse outcomes at 1 year.
CONCLUSIONS
These data suggest that donors who are older, female, or have a long projected ischemic time pose greater risk to heart transplant recipients in the short term. Additionally, certain components of donor management protocols, including antihypertensive and insulin administration, may be protective to recipients.
引言
为解决心脏移植供体心脏短缺的问题，放宽供体接受标准引起了广泛关注。因此，本研究旨在评估器官共享联合网络（UNOS）数据库中的心脏供体特征，以确定其对移植后受体结局的影响。
方法
回顾了2004年7月1日至2012年12月31日在UNOS标准移植分析与研究（STAR）数据库中接受心脏移植的成年（≥18岁）患者。根据移植后1年的状态对患者进行分层；存活者（S组，n = 13,643）和在1年随访时死亡或接受心脏再次移植的患者（NS/R组 = 1785）。为每位受体收集了33个特定的供体变量，并使用多变量逻辑回归分析确定了受体在1年时死亡或再次移植的独立供体预测因素。
结果
整个队列的1年总生存率为88.4%。供体平均年龄为31.5±11.9岁，72%为男性。在多变量逻辑回归分析中，供体年龄>40岁（比值比[OR] 1.44，95%置信区间[CI] 1.27至1.64）、移植物缺血时间>3小时（OR 1.32，1.16至1.51）以及使用心脏停搏液（OR 1.17，1.01至1.35）或Celsior（OR 1.21，1.06至1.38）保存液是移植后1年受体死亡或再次移植的显著预测因素。男性供体性别（OR 0.83，0.74至0.93）以及使用抗高血压药物（OR 0.88，0.77至1.00）或胰岛素（OR 0.84，0.76至0.94）可预防1年时的不良结局。
结论
这些数据表明，年龄较大、女性或预计缺血时间较长的供体在短期内对心脏移植受体构成更大风险。此外，供体管理方案的某些组成部分，包括抗高血压药物和胰岛素的使用，可能对受体有保护作用。
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