Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2021 Mar;111(3):889-898. doi: 10.1016/j.athoracsur.2020.05.163. Epub 2020 Jul 31.
Heart transplantation is the mainstay of treatment for patients in end-stage heart failure. This study sought to contrast survival after transplantation with that of the general population to quantify standardized mortality rates using a nested case-control study design.
Control subjects were noninstitutionalized inhabitants of the United States identified through the National Longitudinal Mortality study. Case subjects were adults who underwent heart transplantation between 1990 and 2007 and identified through the Organ Procurement and Transplantation Network. Propensity-matching (5:1, nearest neighbor, caliper = 0.1) was utilized to identify suitable control subjects based on age, sex, race, and state of permanent residency. The primary study endpoint was 10-year survival.
In all, 31,883 heart transplant recipients were matched to 159,415 noninstitutionalized residents of the United States. The 10-year survival of heart transplant recipients was 53%. The population expected mortality rate was 15.9 deaths per 100 person-years with an observed rate of 45.1 deaths per 100 person-years (standardized mortality rate [SMR] 2.84; 95% confidence interval, 2.82 to 2.87). The broadest gaps between observed and expected survival were evident in female (SMR 3.63), black (SMR 3.67), and Hispanic (SMR 4.12) recipients. Standardized mortality ratios declined over time (1990 to 1995, 3.09; 1996 to 2000, 2.90; 2001 to 2007, 2.58). The long-term standardized survival of older recipients was closest to that expected for their age.
Heart transplant recipients have considerable long-term survival and have a threefold higher standardized long-term mortality rate than that of the noninstitutionalized population. Long-term mortality rates have consistently declined over time and will likely continue to decrease.
心脏移植是治疗终末期心力衰竭患者的主要手段。本研究通过巢式病例对照研究设计，对比移植后患者的生存率与普通人群的生存率，使用标准化死亡率来量化这一结果。
对照组为通过国家纵向死亡率研究确定的非机构化的美国居民。病例组为 1990 年至 2007 年期间接受心脏移植的成年人，通过器官采购和移植网络确定。采用倾向评分匹配（5:1，最近邻，卡尺=0.1），根据年龄、性别、种族和常住州，为合适的对照组匹配患者。主要研究终点为 10 年生存率。
共有 31883 例心脏移植受者与 159415 名非机构化的美国居民相匹配。心脏移植受者的 10 年生存率为 53%。人口预期死亡率为每 100 人年 15.9 例死亡，而观察到的死亡率为每 100 人年 45.1 例死亡（标准化死亡率 [SMR] 2.84；95%置信区间，2.82 至 2.87）。在女性（SMR 3.63）、黑人（SMR 3.67）和西班牙裔（SMR 4.12）受者中，观察到的与预期的生存率之间的差距最大。标准化死亡率随着时间的推移而下降（1990 年至 1995 年，3.09；1996 年至 2000 年，2.90；2001 年至 2007 年，2.58）。年龄较大的受者的长期标准化生存率最接近其年龄的预期生存率。
心脏移植受者具有相当长的长期生存率，其标准化长期死亡率比非机构化人群高三倍。长期死亡率随着时间的推移持续下降，并且可能会继续下降。
