Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2020 Oct;110(4):1308-1315. doi: 10.1016/j.athoracsur.2019.12.081. Epub 2020 Feb 20.
The utilization of multiorgan transplantation in cardiac transplantation has steadily increased over the past several years. We sought to characterize the trends and outcomes in simultaneous heart and other organ transplantation compared with heart transplantation alone.
The United Network for Organ Sharing database was queried for all adult patients (age ≥ 18 y) who underwent isolated heart transplantation or simultaneous heart-lung or heart-kidney transplantation from 1987-2016. Patients were stratified into 3 equal time intervals. Demographics and postoperative outcomes were compared.
A total of 58,060 patients were identified with a distribution based on era. Dual organ recipients had more factors associated with increased operative risk including higher rates of diabetes, pulmonary hypertension, intensive care unit admissions, and dialysis prior to transplantation. Heart-lung and heart-kidney recipients had decreased 1-year survival compared with isolated heart recipients from 2007-2016. However, heart-kidney recipients had significantly increased 5-year post-transplantation survival compared with isolated heart recipients with impaired renal function. For isolated heart transplants and heart-lung transplants, 5-year survival rates improved over time, whereas 5-year survival for heart-kidney recipients did not improve with time.
We found a significantly increased 5-year survival rate for heart-kidney transplant recipients compared with isolated heart transplant recipients with renal impairment. Lack of improvement in 5-year postoperative outcomes for heart-kidney recipients in the setting of higher-risk pretransplant clinical characteristics suggests decreased selectivity regarding heart-kidney recipients. Continued scrutiny and evaluation of postoperative outcomes are required to ensure just and appropriate utilization of organs.
在过去的几年中，心脏移植中多器官移植的应用稳步增加。我们旨在描述与单独心脏移植相比，同时进行心脏和其他器官移植的趋势和结果。
从 1987 年至 2016 年，通过美国器官共享联合网络数据库查询所有接受单独心脏移植或同时进行心肺或心脏-肾脏移植的成年患者（年龄≥18 岁）。患者分为 3 个相等的时间段。比较了人口统计学和术后结果。
共确定了 58060 名患者，其分布基于时代。双器官受者具有更多与手术风险增加相关的因素，包括糖尿病，肺动脉高压，重症监护病房入院和移植前透析的发生率较高。与 2007-2016 年的单独心脏受者相比，心肺和心脏-肾脏受者的 1 年生存率降低。但是，与肾功能受损的单独心脏受者相比，心脏-肾脏受者的 5 年移植后生存率明显提高。对于单独的心脏移植和心肺移植，5 年生存率随着时间的推移而提高，而心脏-肾脏受者的 5 年生存率并未随时间的推移而提高。
我们发现与肾功能受损的单独心脏移植受者相比，心脏-肾脏移植受者的 5 年生存率明显提高。在移植前临床特征风险较高的情况下，心脏-肾脏移植受者的 5 年术后结局并未改善，这表明对心脏-肾脏受者的选择减少。需要继续仔细检查和评估术后结果，以确保器官的公正和合理使用。
