Shafiq Fazal, Wang Yixuan, Li Geng, Liu Zongtao, Li Fei, Zhou Ying, Xu Li, Hu Xingjian, Dong Nianguo
Department of Cardiovascular Surgery, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
J Card Surg. 2020 Feb;35(2):397-404. doi: 10.1111/jocs.14404. Epub 2019 Dec 26.
Due to the shortage of donor pool, there has been a need for organs with prolonged cold ischemic time. This study aims to evaluate the short-term results of different cold ischemic times in orthotopic heart transplantation based on a single-center experience in China.
We retrospectively analyzed outcomes of the heart transplant patients from 1 January 2015 to 31 December 2017. The recipient population was divided into four groups. Group 1: cold ischemic time greater than 8 hours; group 2: the cold ischemic time between 6 and 8 hours; group 3: the cold ischemic time between 4 and 6 hours; and group 4: cold ischemic time less than 4 hours. Efficacy indicators included after transplant survival, infection rate, rejection rate, and complications.
The four groups have similar donor and recipient baseline characteristics (P > .05). Cold ischemic time greater than 8 hours had more cardiopulmonary bypass (CPB) time (127.62 ± 50.23 minutes; P = .003), CPB-assist time (86.14 ± 36.74 minutes; P = .047), and higher intra-aortic balloon pump (IABP) usage rate postoperatively (47.36%; P = .010). Cold ischemic time greater than 8 hours witnessed a relatively higher mortality rate compared with the other three groups (P = .115, P = .078, and P = .114) during the 2-year follow-up. Survival rates of 1 and 2 years for the four groups were 78.95%, 87.13%, 87.32%, and 87.50% and 68.42%, 85.14%, 85.92%, and 83.93%, respectively.
Cold ischemic time less than 8 hours can be reasonably applied to expand the heart transplantation donor pool. Cold ischemic time greater than 8 hours might result in longer CPB time, CPB-assist time, and higher IABP usage postoperatively. It might also affect the in-hospital and 2-years survival rate.
由于供体库短缺，对冷缺血时间延长的器官存在需求。本研究旨在基于中国单中心经验评估原位心脏移植中不同冷缺血时间的短期结果。
我们回顾性分析了2015年1月1日至2017年12月31日心脏移植患者的结局。将受者人群分为四组。第1组：冷缺血时间大于8小时；第2组：冷缺血时间在6至8小时之间；第3组：冷缺血时间在4至6小时之间；第4组：冷缺血时间小于4小时。疗效指标包括移植后生存率、感染率、排斥率和并发症。
四组供体和受者的基线特征相似（P＞0.05）。冷缺血时间大于8小时的患者体外循环（CPB）时间更长（127.62±50.23分钟；P = 0.003），CPB辅助时间更长（86.14±36.74分钟；P = 0.047），术后主动脉内球囊反搏（IABP）使用率更高（47.36%；P = 0.010）。在2年随访期间，冷缺血时间大于8小时的患者死亡率相对高于其他三组（P = 0.115、P = 0.078和P = 0.114）。四组1年和2年生存率分别为78.95%、87.13%、87.32%、87.50%和68.42%、85.14%、85.92%、83.93%。
冷缺血时间小于8小时可合理应用于扩大心脏移植供体库。冷缺血时间大于8小时可能导致CPB时间、CPB辅助时间延长，术后IABP使用率更高。这也可能影响住院期间和2年生存率。
