Chen Carol W, Sprys Michael H, Gaffey Ann C, Chung Jennifer J, Margulies Kenneth B, Acker Michael A, Atluri Pavan
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Heart Lung Transplant. 2017 Jun;36(6):611-615. doi: 10.1016/j.healun.2017.02.001. Epub 2017 Feb 4.
Reduced left ventricular ejection fraction (EF) in the donor heart is often a contraindication for transplant. However, small studies have validated the use of hearts with evidence of myocardial dysfunction to boost the number of organs available for transplant. We hypothesize that donor hearts with reduced EF undergo myocardial recovery after transplant and result in equivalent recipient survival compared with grafts with normal function.
We examined post-operative outcomes of heart recipients in the database of the United Network for Organ Sharing. Patients were grouped by donor EF as follows: <40% (reduced EF); between 40% and 50% (borderline EF); and ≥50% (normal EF). Propensity score matching was performed to compare separately reduced and borderline EF patients with normal EF patients.
Of 30,993 donors from 1996 to 2015, 127 (0.4%) had reduced EF, 613 (2.0%) had borderline EF and 30,253 (97.6%) had normal EF. In each of the 2 propensity score comparisons, the odds of post-operative stroke (p = 0.139, p = 0.551), pacemaker requirement (p = 0.238, p = 0.739), primary graft failure (p = 0.569, p = 0.817), rejection (p = 0.376, p = 0.533) and death at 1 year (p = 0.124, p = 0.247) were equivalent. At roughly 1-year follow-up after transplant, the mean EF of the reduced EF group was 58.0 ± 10.3% compared with 59.5 ± 7.5% in the matched normal EF group (p = 0.289). The mean follow-up EF of the borderline EF group was 58.3 ± 9.1% compared with 59.3 ± 7.7% in the matched normal EF group (p = 0.106).
Recipients of hearts with reduced EF have equivalent 1-year survival compared with recipients of hearts with normal EF. Donor hearts with reduced EF show significant functional recovery after transplant.
供体心脏左心室射血分数（EF）降低通常是移植的禁忌证。然而，小型研究已证实使用有心肌功能障碍证据的心脏可增加可供移植的器官数量。我们假设EF降低的供体心脏在移植后心肌功能会恢复，并且与功能正常的移植物相比，受体的生存率相当。
我们在器官共享联合网络数据库中检查了心脏受体的术后结果。患者按供体EF分组如下：<40%（EF降低）；40%至50%（临界EF）；≥50%（正常EF）。进行倾向评分匹配，以分别比较EF降低和临界EF患者与正常EF患者。
在1996年至2015年的30993名供体中，127名（0.4%）EF降低，613名（2.0%）临界EF，30253名（97.6%）正常EF。在两项倾向评分比较中，术后中风（p = 0.139，p = 0.551）、起搏器需求（p = 0.238，p = 0.739）、原发性移植物功能衰竭（p = 0.569，p = 0.817）、排斥反应（p = 0.376，p = 0.533）和1年死亡率（p = 0.124，p = 0.247）的几率相当。在移植后约1年的随访中，EF降低组的平均EF为58.0±10.3%，而匹配的正常EF组为59.5±7.5%（p = 0.289）。临界EF组的平均随访EF为58.3±9.1%，而匹配的正常EF组为59.3±7.7%（p = 0.106）。
EF降低的心脏受体与正常EF心脏受体的1年生存率相当。EF降低的供体心脏在移植后显示出显著的功能恢复。
