先天性心脏病患者心脏-肝脏联合移植的当代结果。
Contemporary Outcomes of Combined Heart-Liver Transplant in Patients With Congenital Heart Disease.
机构信息
Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
University of Cincinnati College of Medicine, Cincinnati, OH.
出版信息
Transplantation. 2018 Feb;102(2):e67-e73. doi: 10.1097/TP.0000000000001978.
BACKGROUND
As more patients survive into adulthood with repaired congenital heart disease (CHD), transplant centers now have patients presenting with both end-stage cardiac and hepatic failure. An understanding of the contemporary outcomes with combined heart liver transplantation (CHLT) in patients with CHD is needed.
METHODS
A retrospective review of the outcomes of CHLT in CHD was conducted from October 1, 1987, to June 30, 2015, from the United Network of Organ Sharing (UNOS) database. Propensity score matched cohorts were formed for the assessment of posttransplant outcome: CHLT with CHD, CHLT without CHD, and isolated heart transplant for CHD (HT-CHD). Cohorts were matched based on age, body mass index, inotrope use, and ventilator support at the time of transplant. We assessed 30-day, 1-, 5-, and 10-year posttransplant survivals.
RESULTS
There were 61 437 heart transplants during the study period, of which 190 (0.3%) were CHLT. Among CHLT, 41(22%) patients had CHD. In 26 (63%) of these, the indication for CHLT was hepatic congestion/cirrhosis of cardiac origin. In the matched cohorts, the overall survival for CHLT with CHD at 30 days, 1, 5, and 10 years was 95%, 86%, 83%, and 83%, respectively; for CHLT without CHD, it was 100%, 92%, 92%, and 63%, respectively (vs CHLT with CHD: P = 0.49); and for HT-CHD, it was 90%, 84%, 63%, and 39% (vs CHLT with CHD: P = 0.03), respectively.
CONCLUSIONS
The posttransplant outcome of CHLT, with and without CHD, is comparable. However, there is a trend toward better survival for CHLT for CHD compared with isolated heart transplant for CHD.
背景
随着越来越多的先天性心脏病（CHD）患者存活至成年，移植中心现在有患有终末期心脏和肝功能衰竭的患者。因此，需要了解 CHD 患者联合心肝移植（CHLT）的当代结果。
方法
对 1987 年 10 月 1 日至 2015 年 6 月 30 日期间，美国器官共享联合网络（UNOS）数据库中 CHD 患者 CHLT 的结果进行回顾性分析。通过形成倾向评分匹配队列来评估移植后的预后：CHLT 伴 CHD、CHLT 不伴 CHD 和 CHD 的单纯心脏移植（HT-CHD）。根据年龄、体重指数、正性肌力药物的使用和移植时呼吸机支持的情况对队列进行匹配。我们评估了 30 天、1 年、5 年和 10 年的移植后存活率。
结果
研究期间共进行了 61437 例心脏移植，其中 190 例（0.3%）为 CHLT。在 CHLT 中，41 例（22%）患者患有 CHD。其中 26 例（63%）的 CHLT 适应证为心脏来源的肝充血/肝硬化。在匹配的队列中，CHLT 伴 CHD 的 30 天、1 年、5 年和 10 年总生存率分别为 95%、86%、83%和 83%；CHLT 不伴 CHD 的分别为 100%、92%、92%和 63%（与 CHLT 伴 CHD 相比：P=0.49）；HT-CHD 的分别为 90%、84%、63%和 39%（与 CHLT 伴 CHD 相比：P=0.03）。
结论
CHD 患者和非 CHD 患者的 CHLT 移植后结果相当。然而，与 CHD 的单纯心脏移植相比，CHD 患者的 CHLT 有更好的生存趋势。
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