心脏移植治疗终末期心力衰竭的中期结果：257 例患者的单中心经验。
Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients.
机构信息
Department of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, India.
Department of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, India.
出版信息
Indian Heart J. 2020 Nov-Dec;72(6):524-534. doi: 10.1016/j.ihj.2020.09.010. Epub 2020 Sep 19.
OBJECTIVE
End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold.
METHODS
The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category.
RESULTS
There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50.
CONCLUSION
Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country.
目的
终末期心力衰竭是一种致命疾病，5 年生存率极差。心脏移植已被证明是一种在适当选择的此类患者群体中非常有效的治疗方式。这是在印度一家私立医疗机构中对心脏移植中期结果的回顾性分析。本研究的目的有两个。
方法
分析了 2012 年 10 月至 2019 年 10 月在一个单一中心进行的 257 例心脏移植的结果。排除了接受心肺联合移植和完整病历无法获得的患者。在 60 天、90 天、1 年及以后的最长 7 年内追踪生存情况。根据 INTERMACS 类别对术前患者风险特征进行了描述。
结果
患者中男性 176 例，女性 81 例。年龄范围为 8 个月至 78 岁，平均年龄为 32.9 岁。2 个月时存活率为 87%，90 天时为 83%，1 年时为 81%，2 年时为 75%，3 年时为 72%，5 年及以上时为 62%。90 天死亡率的强预测因素包括 INTERMACS 类别（比值比 0.289，p=0.000）和肌酐>1.5mg/dl（比值比 2.48，p=0.056）。受体肺血管阻力和供体器官缺血时间未发现是影响结果的统计学因素。中期生存率受 INTERMACS 类别（与 INTERMACS 4 或 5 相比，INTERMACS 1 类别危险比>3，p<0.0001）和肌酐>1.5mg/dl（危险比 2.15，p=0.003）的影响。肌酐的这种作用与受体的年龄有关。年龄<30 时，危险比为 1.4，p=0.524；年龄>50 时，危险比为 4.78，p=0.006。
结论
即使在发展中国家资源有限的环境中，心脏移植后也能获得令人满意的中期结果。
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