Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
Best Pract Res Clin Anaesthesiol. 2017 Jun;31(2):237-248. doi: 10.1016/j.bpa.2017.06.003. Epub 2017 Jun 23.
Cardiac transplantation remains the gold standard in the treatment of advanced heart failure. With advances in immunosuppression, long-term outcomes continue to improve despite older and higher risk recipients. The median survival of the adult after heart transplantation is currently 10.7 years. While early graft failure and multiorgan system dysfunction are the most important causes of early mortality, malignancy, rejection, infection, and cardiac allograft vasculopathy contribute to late mortality. Chronic renal dysfunction is common after heart transplantation and occurs in up to 68% of patients by year 10, with 6.2% of patients requiring dialysis and 3.7% undergoing renal transplant. Functional outcomes after heart transplantation remain an area for improvement, with only 26% of patients working at 1-year post-transplantation, and are likely related to the high incidence of depression after cardiac transplantation. Areas of future research include understanding and managing primary graft dysfunction and reducing immunosuppression-related complications.
心脏移植仍然是治疗晚期心力衰竭的金标准。随着免疫抑制的进步，尽管受体年龄较大且风险较高，但长期预后仍在不断改善。目前，成人心脏移植后的中位生存时间为 10.7 年。虽然早期移植物衰竭和多器官系统功能障碍是导致早期死亡的最重要原因，但恶性肿瘤、排斥反应、感染和心脏同种异体血管病变导致晚期死亡。心脏移植后慢性肾功能不全很常见，多达 68%的患者在 10 年内发生，其中 6.2%的患者需要透析，3.7%的患者进行肾移植。心脏移植后的功能预后仍然是一个需要改进的领域，只有 26%的患者在移植后 1 年仍能工作，这可能与心脏移植后抑郁的高发生率有关。未来的研究领域包括了解和管理原发性移植物功能障碍以及减少与免疫抑制相关的并发症。
