Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
JACC Heart Fail. 2017 Dec;5(12):879-887. doi: 10.1016/j.jchf.2017.05.004. Epub 2017 Aug 16.
This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts.
Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established.
All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics.
Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07).
In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.
本研究旨在确定青少年（10 至 14 岁）供体心脏的成年受者的结局。
尽管供体器官短缺，但由于缺乏激素激活和左心室质量变化的理论担忧，很少将青少年（不用于儿科患者）供体心脏用于成人，尽管如此，使用青少年供体心脏进行成人移植的结果尚不清楚。
符合本分析条件的是美国器官共享网络数据库中 1994 年 4 月至 2015 年 9 月期间所有成人（≥18 岁）心脏移植受者。将接受青少年供体心脏的受者与接受通常年龄组（18 至 55 岁）供体心脏的受者进行比较。主要结局是 5 年内的全因死亡率和心脏移植物血管病，以及移植后 90 天内的原发性移植物衰竭。采用倾向评分分析确定具有相似基线特征的受者队列。
在 35054 名合格的成年受者中，有 1123 名受者接受了青少年供体心脏，33931 名受者接受了通常年龄的成年供体心脏。使用倾向评分匹配，944 名接受青少年供体心脏的受者与 944 名接受通常年龄成年供体心脏的受者相匹配。在 Cox 风险比和 Kaplan-Meier 分析中，两组在 30 天、1 年、3 年和 5 年的受者存活率或原发性移植物衰竭率方面均无差异。值得注意的是，接受青少年供体心脏的成年患者的心脏移植物血管病发生率呈下降趋势（Cox 风险比为 0.80；95%置信区间：0.62 至 1.01；p=0.07）。
在迄今为止最大的分析中，我们有强有力的证据表明，青少年（不用于儿科患者）供体心脏可安全移植给合适的成年患者，并具有良好的结局。这一发现应有助于增加青少年供体心脏的使用。
