Goel Alexander N, Iyengar Amit, Schowengerdt Kenneth, Fiore Andrew C, Huddleston Charles B
David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA, USA.
Division of Pediatric Cardiology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, St. Louis, MO, USA.
Pediatr Transplant. 2017 Mar;21(2). doi: 10.1111/petr.12858. Epub 2016 Dec 9.
Heart transplantation in children with intellectual disability (ID) is an issue of debate due to the shortage of available donor organs. We sought to perform the first large-scale retrospective cohort study describing the prevalence and outcomes of heart transplantation in this population. The United Network of Organ Sharing database was queried from 2008 to 2015 for pediatric patients (age <19 years) receiving first, isolated heart transplant. Recipients were divided into three subgroups: definite ID, probable ID, and no ID. The chi-square test was used to compare patients' baseline characteristics. Kaplan-Meier and Cox proportional hazard regression analyses were used to estimate the association between ID and death-censored graft failure and patient survival. Over the study period, 565 pediatric patients with definite (131) or probable (434) ID received first heart transplant, accounting for 22.4% of all first pediatric heart transplants (n=2524). Recipients with definite ID did not significantly differ from those without ID in terms of gender, ethnicity, ischemia time, severity of pretransplant condition (waitlist status, mechanical ventilation, inotrope dependence, ECMO, VAD, PVRI, infection prior to transplant), or incidents of acute rejection within the first year. ID was associated with prolonged waitlist time (P<.001). Graft and patient survival at 3 years was equivalent between children with and without ID (P=.811 and .578, respectively). We conclude that intellectual disability is prevalent in children receiving heart transplants, with 22.4% of recipients over the study period having definite or probable ID. ID does not appear to negatively affect transplantation outcomes. Future studies are needed to assess long-term outcomes of transplantation in this population.
由于可用供体器官短缺，为智障（ID）儿童进行心脏移植是一个存在争议的问题。我们试图开展第一项大规模回顾性队列研究，描述该人群心脏移植的患病率和结果。查询了器官共享联合网络数据库2008年至2015年期间接受首次孤立心脏移植的儿科患者（年龄<19岁）。受者被分为三个亚组：确诊ID、可能ID和无ID。采用卡方检验比较患者的基线特征。使用Kaplan-Meier和Cox比例风险回归分析来估计ID与死亡审查的移植物失败和患者生存之间的关联。在研究期间，565名确诊（131名）或可能（434名）ID的儿科患者接受了首次心脏移植，占所有首次儿科心脏移植的22.4%（n = 2524）。确诊ID的受者在性别、种族、缺血时间、移植前病情严重程度（等待名单状态、机械通气、血管活性药物依赖、体外膜肺氧合、心室辅助装置、肺血管阻力指数、移植前感染）或第一年急性排斥反应发生率方面与无ID的受者无显著差异。ID与等待名单时间延长相关（P <.001）。有ID和无ID的儿童3年时的移植物和患者生存率相当（分别为P =.811和.578）。我们得出结论，接受心脏移植的儿童中智障很普遍，在研究期间22.4%的受者有确诊或可能的ID。ID似乎不会对移植结果产生负面影响。需要进一步研究评估该人群移植的长期结果。
