Raissadati Alireza, Pihkala Jaana, Jahnukainen Timo, Jokinen Eero, Jalanko Hannu, Sairanen Heikki
Departments of Pediatric Thoracic and Transplantation Surgery, Pediatric Cardiology and Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Departments of Pediatric Thoracic and Transplantation Surgery, Pediatric Cardiology and Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Interact Cardiovasc Thorac Surg. 2016 Jul;23(1):18-25. doi: 10.1093/icvts/ivw086. Epub 2016 Mar 30.
We studied the long-term survival and rejection episodes of paediatric heart transplant recipients.
We included all paediatric patients (≤18 years) who underwent heart transplantation during 1991-2014 in Finland. Data were obtained retrospectively from a paediatric cardiac surgery database. Patient status was received from the Finnish population registry. All patients underwent yearly routine postoperative endomyocardial biopsies and coronary angiographies.
Between 1991 and 2014, 68 heart transplantations were performed. The early mortality (<30 days after surgery) rate was 10% and follow-up coverage was 100%. The 10- and 15-year survival rates for all patients were 68% (95% confidence internal, CI, 56-80%) and 65% (95% CI 53-78%), respectively, including early mortality. The 1-year survival rate was 100% when excluding early operative mortality. Indications for heart transplantation were cardiomyopathy in 57% and cardiac malformations in 43% of patients, with similar long-term survival between the groups. During 23 years of follow-up, 43 patients (70%) had at least one rejection episode and 17 patients (29%) at least a grade 1 coronary artery vasculopathy finding. Patients with early rejection episodes (<3 months) had a higher incidence of late rejection episodes (P = 0.025). Older age at operation was a significant risk factor for the development of coronary artery vasculopathy (hazard ratio 1.1, 95% CI 1.0-1.3, P = 0.012).
First-year survival was excellent. Asymptomatic rejection episodes were common among patients. Early rejection episodes are a risk factor for late rejection episodes and show a trend towards an increased risk of late death. Coronary artery vasculopathy remains a major challenge for late graft survival.
我们研究了小儿心脏移植受者的长期生存率和排斥反应情况。
我们纳入了1991年至2014年期间在芬兰接受心脏移植的所有小儿患者（≤18岁）。数据从儿科心脏手术数据库中回顾性获取。患者状态来自芬兰人口登记处。所有患者每年进行常规术后心内膜心肌活检和冠状动脉造影。
1991年至2014年期间，共进行了68例心脏移植手术。早期死亡率（术后<30天）为10%，随访覆盖率为100%。所有患者的10年和15年生存率分别为68%（95%置信区间，CI，56 - 80%）和65%（95% CI 53 - 78%），包括早期死亡率。排除早期手术死亡率后，1年生存率为100%。心脏移植的适应证在57%的患者中为心肌病，43%为心脏畸形，两组间长期生存率相似。在23年的随访中，43例患者（70%）至少有一次排斥反应，17例患者（29%）至少有1级冠状动脉血管病变发现。早期发生排斥反应（<3个月）的患者后期排斥反应发生率更高（P = 0.025）。手术时年龄较大是冠状动脉血管病变发生的显著危险因素（风险比1.1，95% CI 1.0 - 1.3，P = 0.012）。
第一年生存率极佳。无症状排斥反应在患者中很常见。早期排斥反应是后期排斥反应的危险因素，且显示出后期死亡风险增加的趋势。冠状动脉血管病变仍然是晚期移植物存活的主要挑战。
