Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Department of Epidemiology and Population Health, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA and.
Eur Heart J. 2021 Dec 21;42(48):4934-4943. doi: 10.1093/eurheartj/ehab416.
Since 1968, heart transplantation has become the definitive treatment for patients with end-stage heart failure. We aimed to summarize our experience in heart transplantation at Stanford University since the first transplantation performed over 50 years ago.
From 6 January 1968 to 30 November 2020, 2671 patients presented to Stanford University for heart transplantation, of which 1958 were adult heart transplantations. Descriptive analyses were performed for patients in 1968-95 (n = 639). Stabilized inverse probability weighting was applied to compare patients in 1996-2006 (n = 356) vs. 2007-19 (n = 515). Follow-up data were updated through 2020. The primary endpoint was all-cause mortality. Prior to weighting, recipients in 2007-19 vs. those in 1996-2006 were older and had heavier burden of chronic diseases. After the application of stabilized inverse probability weighting, the distance organ travelled increased from 84.2 ± 111.1 miles to 159.3 ± 169.9 miles from 1996-2006 to 2007-19. Total allograft ischaemia time also increased over time (199.6 ± 52.7 vs. 225.3 ± 50.0 min). Patients in 2007-19 showed superior survival than those in 1996-2006 with a median survival of 12.1 vs. 11.1 years.
In this half-century retrospective descriptive study from one of the largest heart transplant programmes in the USA, long-term survival after heart transplantation has improved over time despite increased recipient and donor age, worsening comorbidities, increased technical complexity, and prolonged total allograft ischaemia time. Further investigation is warranted to delineate factors associated with the excellent outcomes observed in this study.
自 1968 年以来，心脏移植已成为终末期心力衰竭患者的明确治疗方法。我们旨在总结自 50 多年前首例移植以来斯坦福大学在心脏移植方面的经验。
从 1968 年 1 月 6 日至 2020 年 11 月 30 日，共有 2671 名患者到斯坦福大学接受心脏移植，其中 1958 名为成人心脏移植。对 1968-95 年（n=639）的患者进行描述性分析。应用稳定逆概率加权法比较 1996-2006 年（n=356）和 2007-19 年（n=515）的患者。通过 2020 年更新随访数据。主要终点是全因死亡率。加权前，2007-19 年的受体患者比 1996-2006 年的受体患者年龄更大，慢性病负担更重。应用稳定逆概率加权后，供体器官从 1996-2006 年的 84.2±111.1 英里增加到 2007-19 年的 159.3±169.9 英里。同种异体移植物总缺血时间也随时间延长而增加（199.6±52.7 分钟比 225.3±50.0 分钟）。2007-19 年的患者比 1996-2006 年的患者生存情况更好，中位生存时间分别为 12.1 年和 11.1 年。
在这项来自美国最大的心脏移植项目之一的半个世纪回顾性描述性研究中，尽管受体和供体年龄增加、合并症恶化、技术复杂性增加以及同种异体移植物总缺血时间延长，但心脏移植后的长期生存率仍有所提高。需要进一步研究以阐明与本研究中观察到的良好结果相关的因素。
