Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
J Heart Lung Transplant. 2018 May;37(5):596-603. doi: 10.1016/j.healun.2017.12.015. Epub 2017 Dec 20.
Higher dose norepinephrine donor support is a frequent reason for donor heart decline, but its associations with outcomes after heart transplantation are unclear.
We retrospectively analyzed 965 patients transplanted between 1992 and 2015 in the Heart Transplant Program Vienna. Stratification was performed according to donor norepinephrine dose administered before organ procurement (Group 0: 0 µg/kg/min; Group 1: 0.01 to 0.1 µg/kg/min; Group 2: >0.1 µg/kg/min). Sub-stratification of Group 2 was performed for comparison of high-dose subgroups (Group HD 1: 0.11 to 0.4 µg/kg/min; Group HD 2: >0.4 µg/kg/min). Associations between groups and outcome variables were investigated using a multivariable Cox proportional hazards model and logistic regression analyses.
Donor norepinephrine dose groups were not associated with overall mortality (Group 1 vs 0: hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.87 to 1.43; Group 2 vs 0: HR 1.07, 95% CI 0.82 to 1.39; p = 0.669). No significant group differences were found for rates of 30-day mortality (p = 0.35), 1-year mortality (p = 0.897), primary graft dysfunction (p = 0.898), prolonged ventilation (p = 0.133) and renal replacement therapy (p = 0.324). Groups 1 and 2 showed higher rates of prolonged intensive care unit stay (18.9% vs 28.5% vs 27.5%, p = 0.005). High-dose subgroups did not differ significantly in 1-year mortality (Group HD 1: 14.3%; Group HD 2: 17.8%; p = 0.549).
Acceptance of selected donor hearts supported by higher doses of norepinephrine may be a safe option to increase the donor organ pool.
高剂量去甲肾上腺素供体支持是供体心脏衰竭的常见原因，但它与心脏移植后的结果的关系尚不清楚。
我们回顾性分析了 1992 年至 2015 年间在维也纳心脏移植计划中接受移植的 965 例患者。根据供体器官获取前给予的去甲肾上腺素剂量进行分层（0µg/kg/min 为第 0 组；0.01 至 0.1µg/kg/min 为第 1 组；>0.1µg/kg/min 为第 2 组）。对第 2 组进行亚分层，以比较高剂量亚组（0.11 至 0.4µg/kg/min 为第 HD1 组；>0.4µg/kg/min 为第 HD2 组）。使用多变量 Cox 比例风险模型和逻辑回归分析来研究组与结局变量之间的关系。
供体去甲肾上腺素剂量组与总死亡率无关（第 1 组与第 0 组：危险比[HR]1.12，95%置信区间[CI]0.87 至 1.43；第 2 组与第 0 组：HR1.07，95%CI0.82 至 1.39；p=0.669）。30 天死亡率（p=0.35）、1 年死亡率（p=0.897）、原发性移植物功能障碍（p=0.898）、长时间通气（p=0.133）和肾脏替代治疗（p=0.324）无显著组间差异。第 1 组和第 2 组的 ICU 住院时间延长率较高（18.9%比 28.5%比 27.5%，p=0.005）。高剂量亚组 1 年死亡率无显著差异（第 HD1 组：14.3%；第 HD2 组：17.8%；p=0.549）。
接受接受高剂量去甲肾上腺素支持的选定供体心脏可能是增加供体器官库的安全选择。
