为体重过低或病情严重的婴儿进行心脏移植：这是否明智？
Listing Low-Weight or Ill Infants for Heart Transplantation: Is It Prudent?
机构信息
Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
出版信息
Ann Thorac Surg. 2018 Oct;106(4):1189-1196. doi: 10.1016/j.athoracsur.2018.06.004.
BACKGROUND
Infants awaiting heart transplantation (HTx) have the highest waitlist mortality than other HTx patients. This study analyzed the impact of weight and other factors on waitlist and post-HTx outcomes in infants.
METHODS
All infants on the HTx waitlist in the United Network for Organ Sharing database from October 1987 to June 2016 were divided into the following weight groups: less than 2.5 kg, 2.5 to 3.9 kg, and more than 4 kg. Survival from listing regardless of transplantation was compared by using Kaplan-Meier analysis.
RESULTS
Of 4,711 infants listed for HTx, 250 (5.3%) weighed less than 2.5 kg, 1,993 (42%) weighed 2.5 to 3.9 kg, and 2,468 (52%) weighed more than 4 kg. Median time on the waitlist was similar between the groups weighing less than 2.5 kg and 2.5 to 3.9 kg (28 days versus 31 days, p = 0.423), whereas the group weighing more than 4 kg waited longer (42 days; p = 0.027 and p < 0.001). Infants weighing less than 2.5 kg (1 year, 43%) had the worst survival from listing regardless of transplantation compared with other groups (versus weighing 2.5 to 3.9 kg: 1 year, 54%, p = 0.001; versus weighing >4 kg: 1 year, 66%, p < 0.001). For infants weighing less than 2.5 kg on ventilator support, the 1 year-survival was 35%, on extracorporeal membrane oxygenation (ECMO) it was 10%. For infants weighing 2.5 to 3.9 kg on ventilator support, the 1 year-survival was 45%, on ECMO it was 23%. An infant with congenital heart disease (CHD) on ventilator support awaiting transplantation has a 1 year-survival rate of 37% to 42% regardless of weight. Multivariate analysis found that weighing less than 2.5 kg and being on ventilator support, ECMO, or having CHD were associated with 1-year mortality.
CONCLUSIONS
Survival of infants after being listed for HTx is substantially affected by weight but also by illness at listing. Therefore, going into a transplantation ill or too small, as seen in the present study, may not be prudent, given the limited resource of infant donors.
背景
在等待心脏移植（HTx）的婴儿中，其等待名单死亡率高于其他 HTx 患者。本研究分析了体重和其他因素对婴儿等待名单和移植后结局的影响。
方法
在美国器官共享网络数据库中，1987 年 10 月至 2016 年 6 月期间所有在 HTx 等待名单上的婴儿分为以下体重组：小于 2.5kg、2.5-3.9kg 和大于 4kg。使用 Kaplan-Meier 分析比较了无论是否进行移植，从列入名单到存活的情况。
结果
在 4711 名接受 HTx 治疗的婴儿中，250 名（5.3%）体重小于 2.5kg，1993 名（42%）体重 2.5-3.9kg，2468 名（52%）体重大于 4kg。体重小于 2.5kg 和 2.5-3.9kg 的两组在等待名单上的中位时间相似（28 天与 31 天，p=0.423），而体重大于 4kg 的组等待时间更长（42 天；p=0.027 和 p<0.001）。与其他组相比，体重小于 2.5kg 的婴儿（1 年，43%）无论是否接受移植，其列入名单后存活率最差（与体重 2.5-3.9kg 相比：1 年，54%，p=0.001；与体重>4kg 相比：1 年，66%，p<0.001）。对于呼吸机支持下体重小于 2.5kg 的婴儿，1 年生存率为 35%，体外膜肺氧合（ECMO）为 10%。对于呼吸机支持下体重 2.5-3.9kg 的婴儿，1 年生存率为 45%，ECMO 为 23%。在接受移植的先天性心脏病（CHD）婴儿中，无论体重如何，呼吸机支持的 1 年生存率为 37%至 42%。多变量分析发现，体重小于 2.5kg、使用呼吸机、ECMO 或患有 CHD 与 1 年死亡率相关。
结论
接受 HTx 治疗的婴儿在列入名单后的存活率受到体重的显著影响，但也受到列入名单时疾病的影响。因此，鉴于婴儿供体资源有限，在本研究中，婴儿在等待移植时生病或太小，可能不是明智之举。
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