Kadakia Sagar, Taghavi Sharven, Jayarajan Senthil, Ambur Vishnu, Wheatley Grayson, Kaiser Larry, Toyoda Yoshiya
Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States.
Thorac Cardiovasc Surg. 2017 Aug;65(5):423-429. doi: 10.1055/s-0036-1597989. Epub 2017 Jan 22.
There is a paucity of data on outcomes related to combined heart-lung transplantations (HLTs). Our objective was to identify variables associated with mortality and rejection in HLT. The United Network for Organ Sharing database was reviewed for HLT performed between 1993 and 2008. Long-term survivors (survival > 5 years) were compared with short-term survivors (survival < 5 years). Factors associated with rejection were examined. Risk-adjusted multivariable Cox's proportional hazards regression analysis was performed to examine variables associated with mortality and rejection. Multivariable analysis revealed that recipient male gender was associated with mortality at 1 year (hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.11-2.54, = 0.01) and 5 years (HR: 1.41, 95% CI: 1.05-1.89, = 0.02). Preoperative extracorporeal membrane oxygenation (ECMO) was associated with mortality at 1 year (HR: 7.55, 95% CI: 2.55-22.30, < 0.01) and 5 years (HR: 3.14, 95% CI: 1.19-8.32, = 0.02). Preoperative mechanical ventilation (MV) was associated with mortality at 1 year (HR: 3.51, 95% CI: 1.77-6.98, < 0.01) and at 5 years (HR: 2.70, 95% CI: 1.51-4.85, < 0.01). Multivariable analysis showed that male gender (HR: 1.78, 95% CI: 1.03-3.09, = 0.04) and cytomegalovirus (CMV) positivity in the recipient and donor (HR: 3.09, 95% CI: 1.59-6.01, < 0.01) were associated with rejection. Clinical infection in the donor (HR: 2.05, 95% CI: 1.16-3.61, = 0.01) was also associated with rejection. Survival was affected by recipient male sex and need for preoperative ECMO or MV. Risk factors for rejection included male sex, CMV positivity in the donor and recipient, and donor with clinical infection.
关于心肺联合移植（HLT）相关结局的数据匮乏。我们的目标是确定与HLT死亡率和排斥反应相关的变量。 回顾了器官共享联合网络数据库中1993年至2008年期间进行的HLT情况。将长期存活者（存活时间>5年）与短期存活者（存活时间<5年）进行比较。研究与排斥反应相关的因素。进行风险调整的多变量Cox比例风险回归分析，以研究与死亡率和排斥反应相关的变量。 多变量分析显示，受者男性性别与1年时的死亡率相关（风险比[HR]：1.68，95%置信区间[CI]：1.11 - 2.54，P = 0.01）以及5年时的死亡率相关（HR：1.41，95%CI：1.05 - 1.89，P = 0.02）。术前体外膜肺氧合（ECMO）与1年时的死亡率相关（HR：7.55，95%CI：2.55 - 22.30，P < 0.01）以及5年时的死亡率相关（HR：3.14，95%CI：1.19 - 8.32，P = 0.02）。术前机械通气（MV）与1年时的死亡率相关（HR：3.51，95%CI：1.77 - 6.98，P < 0.01）以及5年时的死亡率相关（HR：2.70，95%CI：1.51 - 4.85，P < 0.01）。多变量分析表明，男性性别（HR：1.78，95%CI：1.03 - 3.09，P = 0.04）以及受者和供者的巨细胞病毒（CMV）阳性（HR：3.09，95%CI：1.59 - 6.01，P < 0.01）与排斥反应相关。供者的临床感染（HR：2.05，95%CI：1.16 - 3.61，P = 0.01）也与排斥反应相关。 存活情况受受者男性性别以及术前是否需要ECMO或MV的影响。排斥反应的风险因素包括男性性别、供者和受者的CMV阳性以及有临床感染的供者。
