From the Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
ASAIO J. 2018 Jul/Aug;64(4):508-514. doi: 10.1097/MAT.0000000000000682.
The effects of pulmonary hypertension (PAH) on survival after heart transplantation are debated, especially for patients with left ventricular assist devices (LVAD). The United Network of Organ Sharing database was retrospectively queried from January 2005 to June 2015 to identify adult patients who underwent heart transplantation. Four groups were defined: patients without PAH, persistent PAH, resolved PAH, and developed PAH between listing and transplant. A total of 15,914 patients underwent heart transplant of which 4,662 (29%) were implanted with an LVAD. Of the total population, 10,872 (68%) had PAH at time of listing and 9,661 (61%) had PAH at time of transplant. Long-term survival was significantly worse for patients with an LVAD than for those without who had PAH at time of transplant (p = 0.010). Kaplan-Meier analysis showed a trend of worse long-term survival for patients with an LVAD who developed PAH by the time of transplant but improved survival for patients with resolved PAH while on LVAD therapy (p = 0.052). PAH at time of transplant results in worse long-term survival for patients with an LVAD. Furthermore, the development of PAH while on LVAD therapy may negatively impact long-term post-transplant survival, while resolution of PAH improves long-term survival.
肺动脉高压（PAH）对心脏移植后存活的影响存在争议，尤其是对于左心室辅助装置（LVAD）患者。本研究回顾性分析了 2005 年 1 月至 2015 年 6 月期间接受心脏移植的成年患者的 United Network of Organ Sharing 数据库，以确定患者是否存在 PAH。根据患者的 PAH 状态，将其分为 4 组：无 PAH、持续 PAH、已缓解 PAH 和移植前发生 PAH。共纳入 15914 例患者，其中 4662 例（29%）植入了 LVAD。在总人群中，10872 例（68%）在列表时存在 PAH，9661 例（61%）在移植时存在 PAH。与移植时存在 PAH 的无 LVAD 患者相比，LVAD 患者的长期存活率明显较差（p = 0.010）。Kaplan-Meier 分析显示，LVAD 患者在移植时发生 PAH 的长期存活率呈下降趋势，但接受 LVAD 治疗时 PAH 缓解的患者的存活率有所改善（p = 0.052）。LVAD 患者移植时存在 PAH 会导致长期存活率降低。此外，LVAD 治疗期间发生 PAH 可能会对移植后长期生存产生负面影响，而 PAH 的缓解则会改善长期生存。
