在接受高危供体心脏的心脏移植患者中，生存、移植物功能和同种异体移植血管病的发生率。

Survival, graft function, and incidence of allograft vasculopathy in heart transplant patients receiving adverse risk profile donor hearts.

机构信息

Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.

Department of Clinical Immunology, Aarhus University Hospital, Skejby, Aarhus, Denmark.

出版信息

Clin Transplant. 2018 Aug;32(8):e13343. doi: 10.1111/ctr.13343. Epub 2018 Jul 29.

DOI:10.1111/ctr.13343

PMID:29974979

Abstract

AIM

To clarify if use of adverse cardiovascular risk profile (ARP) grafts is associated with impaired long-term outcomes after heart transplantation (HTx).

METHODS

Survival was obtained from Scandia Transplant and a local database.

ARP DONOR INCLUSION CRITERIA

≥55 years, diabetes mellitus, arterial hypertension, hypoxemia-induced death, impaired left ventricular (LV) ejection fraction. ARP donors were compared to donors not meeting the eligibility criteria. Sub-analyses were made for donor age.

RESULTS

In total, 302 HTxs were performed in 296 patients from 31 December 1992 to 11 August 2016. Median survival was 16.5 years (95% CI, 14.3-22.9), there was no difference between profiles (HR 0.63 (95% CI, 0.33-1.19), P = 0.15). LV systolic function was significantly better in ARP donors (P < 0.05). Freedom from cardiac allograft vasculopathy (CAV) was comparable between profiles, HR 0.9 (95% CI 0.5-1.5). Donor age predisposes to CAV (high to low age: HR 2.8 (95% CI 1.7-4.5), P < 0.0001). Median survival was comparable in patients receiving allograft ≥55 and <55 years (HR 0.77 (95% CI 0.4-1.4), P = 0.38).

CONCLUSION

Long-term survival and graft function were excellent in patients receiving ARP grafts. Older grafts were associated with CAV but did not influence survival. Thus, the strategy of expanding availability using ARP grafts seems safe.

摘要

目的

明确使用不良心血管风险供体（ARP）是否与心脏移植（HTx）后长期预后受损相关。

方法

通过 Scandia 移植和当地数据库获得生存数据。

ARP 供体纳入标准：≥55 岁、糖尿病、动脉高血压、低氧血症导致的死亡、左心室（LV）射血分数受损。ARP 供体与不符合入选标准的供体进行比较。对供体年龄进行亚组分析。

结果

1992 年 12 月 31 日至 2016 年 8 月 11 日期间，共有 296 例患者进行了 302 例 HTx。中位生存时间为 16.5 年（95%可信区间，14.3-22.9），两组间无差异（HR 0.63（95%可信区间，0.33-1.19），P=0.15）。ARP 供体的 LV 收缩功能明显更好（P<0.05）。两组间的心脏移植物血管病（CAV）无差异，HR 0.9（95%可信区间 0.5-1.5）。供体年龄易导致 CAV（高年龄到低年龄：HR 2.8（95%可信区间 1.7-4.5），P<0.0001）。接受≥55 岁和<55 岁供体的患者中位生存时间相当（HR 0.77（95%可信区间 0.4-1.4），P=0.38）。