Wang Yixuan, Cai Jie, Sun Yongfeng, Zhang Jing, Xie Fei, Alshirbini Mahmoud H, Shi Jiawei, Dong Nianguo
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Cardiovascular Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
J Thorac Dis. 2018 Apr;10(4):2153-2165. doi: 10.21037/jtd.2018.03.149.
Heart donor selection criteria have been progressively widened due to increasing donor recipient mismatch. This study evaluates the outcomes of the use marginal donor hearts for orthotopic heart transplantation (OHT) based on a single center experience in China.
We retrospectively analyzed outcomes of patients undergoing OHT in our hospital between September 2008 and December 2015. All the donor hearts were from voluntary donation of brain-dead patients. The primary outcome was overall survival; secondary outcomes included cardiopulmonary bypass (CPB) time, ventilation time, post-operative mechanical support and medium-term complications.
Overall, 278 patients with OHT were analyzed. Whereas 180 patients (64.7%) underwent OHT utilizing marginal donors (MD group), only 98 patients (35.3%) underwent OHT with standard donors (SD group). Compared to the SD group, the MD group had longer CPB time (P=0.001), ventilation time (P=0.010) and increased mechanical support rate (P=0.011). Survival rates were comparable between the two groups at 30 days, 1 year, 3 years and 5 years (92.2%, 83.3%, 70.6%, 70.6% 95.9%, 91.4%, 80.2%, 80.2% respectively). Multivariate Cox regression analysis revealed that female recipient gender [hazard ratio (HR) =2.632 (1.325-5.227), P=0.006], diagnosis (P=0.014) and abnormal donor heart structure [HR =3.638 (1.005-13.167), P=0.049] were three predictors for 1-year all-cause mortality. The occurrence of complications in the recipients with more than 3-year follow-up did not differ between the two cohorts.
Marginal donor can be reasonably applied to expand the benefits of transplantation. Changing previous MD criteria to include donors with an age greater than 50 years, cold ischemic time less than 6 hours, donor/recipient weight ratio less than 0.8, compatible blood type, hepatitis virus seropositivity and MD used for male recipient will likely offer a good prognosis.
由于供体与受体的匹配度不断下降，心脏供体选择标准已逐渐放宽。本研究基于中国某单中心经验，评估了使用边缘供体心脏进行原位心脏移植（OHT）的结果。
我们回顾性分析了2008年9月至2015年12月在我院接受OHT的患者的结果。所有供体心脏均来自脑死亡患者的自愿捐献。主要结局为总体生存率；次要结局包括体外循环（CPB）时间、通气时间、术后机械支持及中期并发症。
总体而言，共分析了278例接受OHT的患者。其中180例患者（64.7%）使用边缘供体进行OHT（MD组），仅98例患者（35.3%）使用标准供体进行OHT（SD组）。与SD组相比，MD组的CPB时间更长（P = 0.001）、通气时间更长（P = 0.010）且机械支持率更高（P = 0.011）。两组在30天、1年、3年和5年时的生存率相当（分别为92.2%、83.3%、70.6%、70.6%和95.9%、91.4%、80.2%、80.2%）。多变量Cox回归分析显示，女性受体性别[风险比（HR）= 2.632（1.325 - 5.227），P = 0.006]、诊断（P = 0.014）和供体心脏结构异常[HR = 3.638（1.005 - 13.167），P = 0.049]是1年全因死亡率的三个预测因素。两组随访超过3年的受体并发症发生率无差异。
边缘供体可合理应用以扩大移植受益。将先前的边缘供体标准改为包括年龄大于50岁、冷缺血时间小于6小时、供体/受体体重比小于0.8、血型相容、肝炎病毒血清学阳性以及用于男性受体的边缘供体，可能会带来良好的预后。
