Javier Delmo Eva Maria, Javier Mariano Francisco Del Maria, Wagner Frank, Hetzer Roland
Universitätsmedizin Berlin-Charité, Charité Research Organization, Berlin, Germany.
Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany.
Cardiovasc Diagn Ther. 2021 Feb;11(1):164-170. doi: 10.21037/cdt-20-286.
Heart transplantation has extended the lives of many patients with end-stage heart failure. Although beset with the arduous aftermaths of immunosuppression, those who survived live meaningful lives similar to that of the general population. In this series, heart transplantation has led to a considerable extension of life span of >31-34 years. Development of cardiac allograft vasculopathy is a major concern in the long-term follow-up of transplant patients. Immunosuppressive drugs have a major impact on the development and progression of cardiac allograft vasculopathy and the main cause of cardiac allograft loss after the first post-transplantation year. Post-transplant neoplasia remains a challenging long-term problem for patients after orthotopic heart transplantation. Post-transplant lymphoproliferative disease appears to be largely the result of the effectiveness of current agents used for long-term immunosuppression, and the neoplasms typically harbor the Epstein Barr virus genome, which is presumed to play a major role in neoplastic transformation. Post-transplantation, new diseases may occur or there may be worsening of pre-existing diseases. By the end of the 5 year, all suffered from hypertension. Renal insufficiency developed within 5 years after transplantation, and 10% have a creatinine value of >2.5 mg/dL. Hyperlipidemia, mostly hypercholesterolemia occurs especially in patients on tacrolimus or everolimus. Quality of life is not impaired despite somatic problems. In this period >31 years post-post-orthotopic heart transplantation, they even reported a surprising increase in their emotional well-being. The 10 patients are active and satisfied with their daily lives. They regard their own life as meaningful, have good families and active social relations. Nonetheless, it is burdened by chronic allograft vasculopathy and immunosuppression sequelae, the main limiting factors for survival, which needed to be constantly addressed throughout their lifetime. This brief report provides an insight into the challenges and burden patients living >31 years with transplanted hearts are confronted with.
心脏移植延长了许多终末期心力衰竭患者的生命。尽管面临免疫抑制带来的艰巨后果，但存活下来的患者过着与普通人群相似的有意义的生活。在这个系列中，心脏移植使患者的寿命显著延长了31至34年。心脏移植血管病变的发展是移植患者长期随访中的一个主要问题。免疫抑制药物对心脏移植血管病变的发生和发展有重大影响，并且是移植后第一年之后心脏移植失败的主要原因。移植后肿瘤形成仍然是原位心脏移植患者面临的一个具有挑战性的长期问题。移植后淋巴组织增生性疾病似乎主要是目前用于长期免疫抑制的药物有效性的结果，并且这些肿瘤通常携带爱泼斯坦-巴尔病毒基因组，据推测该病毒基因组在肿瘤转化中起主要作用。移植后，可能会出现新的疾病，或者原有疾病可能会恶化。到5年结束时，所有人都患有高血压。移植后5年内出现肾功能不全，10%的患者肌酐值>2.5mg/dL。高脂血症，主要是高胆固醇血症，尤其在使用他克莫司或依维莫司的患者中出现。尽管存在身体问题，但生活质量并未受损。在原位心脏移植术后超过31年的这段时间里，他们甚至报告称自己的情绪幸福感有惊人的提升。这10名患者生活积极，对日常生活感到满意。他们认为自己的生活有意义，有良好的家庭和活跃的社会关系。尽管如此，他们仍受到慢性移植血管病变和免疫抑制后遗症的困扰，这些是生存的主要限制因素，在他们的一生中都需要不断应对。这份简短的报告深入探讨了心脏移植后存活超过31年的患者所面临的挑战和负担。
