Blitzer David, Baran David A, Lirette Seth, Copeland Jack G, Copeland Hannah
Columbia University, Department of Surgery, Division of Cardiovascular Surgery, New York, New York, USA.
Cleveland Clinic Heart Vascular and Thoracic Institute, Weston, Florida, USA.
Clin Transplant. 2023 Apr;37(4):e14912. doi: 10.1111/ctr.14912. Epub 2023 Jan 28.
The purpose was to evaluate the effects of the most commonly used cardiac donor inotropes/vasopressors on subsequent post-heart transplant survival.
Adult heart transplant recipients from January 2000 to June 2022 were identified in the United Network for Organ Sharing (UNOS) database. Exclusion criteria included: multiorgan transplants, donor age < 15, and recipient age < 18. Donors receiving vasoactive medications at the time of procurement were compared to donors not receiving these medications. Those on vasoactive medications were stratified by medication: phenylephrine, dopamine, dobutamine, norepinephrine and epinephrine, the combination of these agents, and the concomitant administration of vasopressin with any single agent alone or in combination. The primary area of interest was short-and-long-term survival. Survival at 30 days, 1 year, and long-term (Median = 13.6 years) was compared using logistic and Cox models to quantify survival endpoints.
A total of 45,198 donors met inclusion criteria and had data on the use of vasoactive agents available. Mean donor age was 32.3 years with 71% male. Vasoactive medications and potential combinations included phenylephrine in 8156 donors (18.0%), dopamine in 9550 (21.1%), dobutamine in 718 (1.6%), epinephrine in 332 (.73%), and norepinephrine in 4854 (10.7%). A total of 25,856 donors (57.2%) were receiving vasopressin at the time of procurement. There was no impact of donor inotropes on 30-day survival. Donors receiving one inotrope and no vasopressin were associated with increased 1 year mortality (OR 1.14; p = .021), as were donors receiving 2+ inotropes and no vasopressin (OR 1.26; p = .006). For individual agents, 1 year mortality was increased for dopamine (OR 1.11; p = .042) and epinephrine (OR 1.59; p = .004).
There is no difference in heart transplant recipient survival at 30 days when the donor is receiving inotropes without vasopressin at the time of procurement. Inotropic support without vasopressin is associated with greater 1 year mortality. The impact of donor inotropic support on long term heart transplant survival, and the interaction with vasopressin warrants further study.
评估最常用的心脏供体强心剂/血管升压药对心脏移植术后生存的影响。
在器官共享联合网络（UNOS）数据库中识别出2000年1月至2022年6月的成年心脏移植受者。排除标准包括：多器官移植、供体年龄<15岁以及受体年龄<18岁。将在获取时接受血管活性药物治疗的供体与未接受这些药物治疗的供体进行比较。接受血管活性药物治疗的供体按药物分层：去氧肾上腺素、多巴胺、多巴酚丁胺、去甲肾上腺素和肾上腺素、这些药物的组合，以及血管加压素与任何单一药物单独或联合使用。主要关注领域是短期和长期生存。使用逻辑回归和Cox模型比较30天、1年和长期（中位数=13.6年）的生存率，以量化生存终点。
共有45198名供体符合纳入标准，并可获得血管活性药物使用数据。供体平均年龄为32.3岁，71%为男性。血管活性药物及其潜在组合包括：8156名供体（18.0%）使用去氧肾上腺素，9550名（21.1%）使用多巴胺，718名（1.6%）使用多巴酚丁胺，332名（0.73%）使用肾上腺素，4854名（10.7%）使用去甲肾上腺素。共有25856名供体（57.2%）在获取时接受血管加压素治疗。供体强心剂对30天生存率没有影响。接受一种强心剂且未使用血管加压素的供体1年死亡率增加（OR 1.14；p = 0.021），接受2种及以上强心剂且未使用血管加压素的供体也是如此（OR 1.26；p = 0.006）。对于个别药物，多巴胺（OR 1.11；p = 0.042）和肾上腺素（OR 1.59；p = 0.004）的1年死亡率增加。
当供体在获取时接受不使用血管加压素的强心剂治疗时，心脏移植受者30天生存率没有差异。不使用血管加压素的强心支持与更高的1年死亡率相关。供体强心支持对心脏移植长期生存的影响以及与血管加压素的相互作用值得进一步研究。
