Dellgren Göran, Westerlind Andreas, Liden Hans, Gäbel Jakob, Bartfay Sven-Erik, Bollano Entela, Holmberg Erik, Andersson Bert, Schersten Henrik, Karason Kristjan
Transplant Institute, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden; Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
Int J Cardiol. 2017 Mar 15;231:188-194. doi: 10.1016/j.ijcard.2016.12.186. Epub 2017 Jan 4.
Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. We report on the long-term outcome after HTx at our centre and investigate trends in outcome over time.
During the period, between 1984 and 2014, a total of 610 HTx procedures were performed in 595 patients (median 48years; IQR 31-57years; range 24days-71years; mean 43years; 75% male) in our institution. Long-term outcome was investigated in the whole cohort, among children (n=76), bridged with mechanical circulatory support (MCS, n=131), re-transplanted (n=17), and concomitant kidney transplantation (n=12).
Long-term survival was at 1, 5, 10, 15 and 20years: 86% (95CI 0.83-0.89); 77% (95CI 0.73-0.80); 63% (95CI 0.59-0.68); 48% (95CI 0.43-0.54) and 30% (95CI 0.25-0.36), respectively. The median survival for the whole cohort was 14.1years. Patients transplanted during the most recent time period (2010-2014) had a better survival compared to previous eras, with a 1- and 3-year survival of 94% (95CI 0.89-0.97) and 93% (95CI 0.88-0.96), respectively (p<0.001). However, when survival was analysed for long-term MCS (n=80) versus short term MCS (n=35), there was a significantly poorer survival for the short-term MCS group (p=0.001). Independent predictors of long-term mortality included recipient age (p=0.041); previous smoking (p=0.034); ischemic heart disease (p=0.002); and preoperative ventilator therapy (p=0.004).
We have shown that continuous improvement in outcome after HTx still occurs. In the last time era, direct transplantation from short-term MCS was abandoned, which may have inflicted outcome during the last time era.
心脏移植已成为终末期心脏病患者的标准治疗方法。我们报告了本中心心脏移植后的长期结果，并调查了结果随时间的变化趋势。
在1984年至2014年期间，我们机构共对595例患者（年龄中位数48岁；四分位间距31 - 57岁；范围24天至71岁；平均43岁；75%为男性）进行了610例心脏移植手术。对整个队列、儿童患者（n = 76）、接受机械循环支持（MCS）过渡的患者（n = 131）、再次移植的患者（n = 17）以及同期进行肾移植的患者（n = 12）的长期结果进行了调查。
1年、5年、10年、15年和20年的长期生存率分别为：86%（95%置信区间0.83 - 0.89）；77%（95%置信区间0.73 - 0.80）；63%（95%置信区间0.59 - 0.68）；48%（95%置信区间0.43 - 0.54）和30%（95%置信区间0.25 - 0.36）。整个队列的中位生存期为14.1年。与之前的时期相比，最近时期（2010 - 2014年）接受移植的患者生存率更高，1年和3年生存率分别为94%（95%置信区间0.89 - 0.97）和93%（95%置信区间0.88 - 0.96）（p < 0.001）。然而，当对长期使用MCS（n = 80）与短期使用MCS（n = 35）的患者生存率进行分析时，短期MCS组的生存率明显更低（p = 0.001）。长期死亡率的独立预测因素包括受者年龄（p = 0.041）；既往吸烟史（p = 0.034）；缺血性心脏病（p = 0.002）；以及术前呼吸机治疗（p = 0.004）。
我们已经表明心脏移植后的结果仍在持续改善。在最后一个时期，放弃了短期MCS直接移植，这可能影响了最后一个时期的结果。
