利用脑死亡为创伤性模式的供体进行心脏移植后长期预后得到改善。
Improved long-term outcomes after heart transplantation utilizing donors with a traumatic mode of brain death.
作者信息
Ram Eilon, Lavee Jacob, Freimark Dov, Maor Elad, Kassif Yigal, Sternik Leonid, Kogan Alexander, Peled Yael
机构信息
Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
J Cardiothorac Surg. 2019 Jul 22;14(1):138. doi: 10.1186/s13019-019-0963-2.
BACKGROUND
The donor's mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient.
METHODS
All patients who underwent HTx between 1996 and 2017 were categorized according to donor's BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD).
RESULTS
The TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p = 0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42-0.75, p = 0.033]. Rejection rate was lower in the TBD group (total rejection score 0.44 ± 0.32 vs. 0.51 ± 0.38, p = 0.04; any rejection score 0.38 ± 0.26 vs. 0.45 ± 0.31, p = 0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10 years: 82.9 vs. 62.4%, log-rank p-value = 0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR) = 0.58, 95% CI 0.51-0.85, p = 0.022).
CONCLUSION
Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.
背景
供体的脑死亡（BD）模式与心肌功能和血流动力学表现受损相关，影响心脏移植（HTx）受者的预后。
方法
将1996年至2017年间接受HTx的所有患者根据供体的BD机制进行分类：外伤性脑死亡（TBD）与非外伤性脑死亡（NTBD）。
结果
TBD组包括105名受者，NTBD组包括85名受者。Kaplan-Meier生存分析显示，TBD心脏受者的总体生存率显著更高（10年生存率58.1%对37.6%，p = 0.044）。同样，多变量分析显示，TBD与死亡率显著降低43%独立相关[95%置信区间（CI）0.42 - 0.75，p = 0.033]。TBD组的排斥率较低（总排斥评分0.44±0.32对0.51±0.38，p = 0.04；任何排斥评分0.38±0.26对0.45±0.31，p = 0.030），外伤性供体受者无心脏移植血管病变（CAV）的比例显著高于非外伤性供体受者（10年：82.9%对62.4%，对数秩p值 = 0.024）。多变量分析显示CAV显著降低42%[风险比（HR）= 0.58，95% CI 0.51 - 0.85，p = 0.022]。
结论
脑死亡模式显著影响HTx结果，TBD与死亡率、排斥反应和CAV降低相关。
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