Gaffey Ann C, Chen Carol W, Chung Jennifer, Grandin Edward Wilson, Porrett Paige M, Acker Michael A, Atluri Pavan
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
J Card Surg. 2017 Mar;32(3):209-214. doi: 10.1111/jocs.13105. Epub 2017 Feb 8.
Left ventricular assist device (LVAD) implantation as a bridge to cardiac transplantation (BTT) is an effective treatment for end-stage heart failure patients. Currently, there is an increasing number of patients with a LVAD who need a heart and kidney transplant (HKT). Little is known of the prognostic outcomes in these patients. This study was undertaken to determine whether an equivalent outcome would be present in HKTs as compared to a non-LVAD primary HKT cohort.
We reviewed the United Network for Organ Sharing database from 2004 to 2013. Orthotropic heart transplant recipients (n = 49 799) were subcategorized as dual organ HKT (n = 1 921) and then divided into cohorts of HKT following continuous flow left ventricular assist device placement (CF-VAD-HKT, n = 113) or no LVAD placement (HKT, n = 1 808). Survival after transplantation was analyzed.
For CF-LVAD-HKT and HKT cohorts, preoperative characteristics were similar regarding age (50.8 ± 13.7, 50.1 ± 13.7, p = 0.75) and panel reactive antibody (12.3 ± 18.4 vs 7.1 ± 18.4, p = 0.06). Donors were similar in age, gender, creatinine, and ejection fraction. Post-transplant, there was no difference in complications. Survival for CF-LVAD-HKT and HKT were similar at 1 year (77% vs 82%) and 3 years (75% vs 77%, log rank p = 0.2814).
For patients with advanced heart failure and persistent renal dysfunction, simultaneous HKT is a safe option. Survival after CF-LVAD-HKT is equivalent to conventional HKT.
植入左心室辅助装置（LVAD）作为心脏移植（BTT）的桥梁是终末期心力衰竭患者的一种有效治疗方法。目前，需要心脏和肾脏移植（HKT）的LVAD患者数量不断增加。对于这些患者的预后结果知之甚少。本研究旨在确定与非LVAD原发性HKT队列相比，HKT患者是否会有相同的结果。
我们回顾了2004年至2013年器官共享联合网络数据库。原位心脏移植受者（n = 49799）被细分为双器官HKT（n = 1921），然后分为连续流左心室辅助装置植入后进行HKT的队列（CF-VAD-HKT，n = 113）或未植入LVAD的队列（HKT，n = 1808）。分析移植后的生存率。
对于CF-LVAD-HKT和HKT队列，术前年龄（50.8±13.7，50.1±13.7，p = 0.75）和群体反应性抗体（12.3±18.4对7.1±18.4，p = 0.06）方面的特征相似。供体在年龄、性别、肌酐和射血分数方面相似。移植后，并发症无差异。CF-LVAD-HKT和HKT在1年时的生存率相似（77%对82%），3年时也相似（75%对77%，对数秩检验p = 0.2814）。
对于晚期心力衰竭和持续性肾功能不全的患者，同时进行HKT是一种安全的选择。CF-LVAD-HKT后的生存率与传统HKT相当。
