Quintana-Quezada R A, Rajapreyar I, Postalian-Yrausquin A, Yeh Y C, Choi S, Akkanti B, Sieg A, Weeks P, Patel M, Patel J, Nathan S, Kar B, Loyalka P, Gregoric I
Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
Transplant Proc. 2016 Jul-Aug;48(6):2168-71. doi: 10.1016/j.transproceed.2016.02.073.
Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD.
Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015.
The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively].
Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
原发性移植肝无功能（PGD）是心脏移植术后常见的并发症，仍是这些患者死亡的主要原因之一。本病例对照研究的目的是确定与PGD相关的供体和手术因素，并进一步指导预防PGD的可能策略。
回顾性分析2012年10月至2015年2月在德克萨斯医学中心纪念赫尔曼医院接受心脏移植患者的病历。
研究人群包括99例患者，其中18例发生PGD。对供体特征的单因素分析显示，使用阿片类药物（P = 0.049）和因缺氧死亡（P = 0.021）与PGD相关。受者/供者血型匹配AB/A与PGD显著相关（P = 0.031）。脑死亡至主动脉阻断时间（TBDACC）≥3天和≥5天也与PGD相关（分别为P = 0.0011和P = 0.0003）。多因素分析证实，脑死亡至主动脉阻断时间≥3天和≥5天的患者发生PGD的几率较低（优势比分别为0.098 [P = 0.0026]和0.092 [P = 0.0017]）。
我们的研究表明，脑死亡至主动脉阻断时间较长与发生PGD的几率较低相关。因此，在脑死亡后推迟几天进行心脏获取似乎有利于预防PGD。
