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):1339-1347. doi: 10.1016/j.athoracsur.2020.02.014. Epub 2020 Mar 12.
Survival after heart transplantation is typically reported only in terms of overall survival. Conditional survival may provide prognostic information for patients after surviving a given period. This study sought to provide an analysis of conditional survival in heart transplantation.
Data from 29,000 patients who underwent heart transplantation between 2002 and 2016 were analyzed from the Organ Procurement and Transplantation Network database, and 5-year conditional survival rates were calculated according to age, sex, race, renal function, and hepatic function at transplantation.
As time from transplantation increased from 0 to 5 years, the 5-year observed conditional survival changed from 74% to 82% for ages younger than 40 years, 79% to 82% for ages 40 to 49, 79% to 78% for ages 50 to 60, and 75% to 70% for ages older than 60 at transplantation. Conditional survival peaked at 1 and 2 years after transplantation for most subgroups. In recipients younger than 40 years, men had slightly higher conditional survival than women (absolute difference, 3%-4%). In recipients older than 60 years, women had slightly higher conditional survival (absolute difference, 1%-4%). Black recipients had lower survival than white and Hispanic recipients for nearly all time points. Recipients younger than 40 years with the worst renal (65% to 88%) and hepatic function (66% to 83%) at transplantation experienced the largest increase in conditional survival.
The conditional survival of patients who undergo heart transplantation changes substantially over time. The largest increases in conditional survival are in young patients with impaired renal and hepatic function. Conditional survival can provide more accurate prognostic information for heart recipients who survive a given period after transplantation.
心脏移植后的存活率通常仅以总存活率的形式报告。条件存活率可能为存活一定时间后的患者提供预后信息。本研究旨在对心脏移植的条件存活率进行分析。
从 2002 年至 2016 年间进行心脏移植的 29000 名患者的 Organ Procurement and Transplantation Network 数据库中分析数据，并根据移植时的年龄、性别、种族、肾功能和肝功能计算 5 年条件存活率。
随着移植后时间从 0 年增加到 5 年，年龄小于 40 岁的患者的 5 年观察条件存活率从 74%变为 82%，40 至 49 岁的患者从 79%变为 82%，50 至 60 岁的患者从 79%变为 78%，而 60 岁以上的患者从 75%变为 70%。大多数亚组的条件存活率在移植后 1 年和 2 年达到峰值。在年龄小于 40 岁的患者中，男性的条件存活率略高于女性（绝对差异，3%-4%）。在年龄大于 60 岁的患者中，女性的条件存活率略高（绝对差异，1%-4%）。在几乎所有时间点，黑皮肤患者的存活率均低于白人和西班牙裔患者。移植时肾功能最差（65%至 88%）和肝功能最差（66%至 83%）的年龄小于 40 岁的患者，其条件存活率增加最大。
接受心脏移植的患者的条件存活率随时间发生显著变化。在肾功能和肝功能受损的年轻患者中，条件存活率的增加最大。条件存活率可以为移植后存活一定时间的心脏接受者提供更准确的预后信息。
