在婴儿心脏移植中，供体与受体体重不匹配的增加与更短的等待时间相关，且不会增加发病率或死亡率。
Increasing donor-recipient weight mismatch in infant heart transplantation is associated with shorter waitlist duration and no increased morbidity or mortality.
机构信息
Department of Cardiothoracic Surgery, University of Louisville and Norton Children's Hospital, Louisville, KY, USA.
Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, KY, USA.
出版信息
Eur J Cardiothorac Surg. 2023 Dec 1;64(6). doi: 10.1093/ejcts/ezad316.
OBJECTIVES
Infants awaiting paediatric heart transplantation (PHT) experience long waitlist duration and high mortality due to donor shortage. Using the United Network for Organ Sharing database, we explored if increasing donor-recipient weight ratio (DRWR) >2.0 (recommended cutoff) was associated with adverse outcomes.
METHODS
Between 2007 and 2020, 1392 infants received PHT. We divided cohort into 3 groups: A (DRWR ≤1.0, n = 239, 17%), B (DRWR 1.0-2.0, n = 947, 68%), C (DRWR >2.0, n = 206, 15%). Group characteristics and PHT outcomes were analysed.
RESULTS
DRWR ranged between 0.5 and 4.1. Underlying pathology (congenital versus cardiomyopathy), gender, race, renal function and mechanical circulatory support were comparable between groups. Group C patients were more likely to be ventilated, to receive ABO blood group (ABO)-incompatible heart and to have longer donor ischaemic time. Waitlist duration was significantly shorter for group C (33 vs 50 days, P < 0.1). Early outcomes for groups A, B and C were the following (respectively): operative death (6%, 4%, 3%, P = 0.29), primary graft dysfunction (5%, 3%, 3%, P = 0.30), renal failure (10%, 7%, 7%, P = 0.42) and stroke (3%, 4%, 1%, P = 0.36). The DRWR group was not associated with operative death in either congenital (odds ratio (OR) = 0.819, 95% confidence interval (CI) = 0.523-1.282) or cardiomyopathy (OR = 1.221, 95% CI = 0.780-1.912) patients and only significant factor was pre-PHT extracorporeal membrane oxygenation (OR = 4.400, 95% CI = 2.761-7.010). Additionally, survival at 1 year (87%, 87%, 85%, P = 0.80) and 5 years (76%, 78%, 77%, P = 0.80) was comparable between the DRWR groups.
CONCLUSIONS
Infants who received PHT with DRWR >2.0, up to 4.1, experienced shorter waitlist duration with no demonstrable increase in peri-transplant complications, operative or late mortality. Historic practice to avoid DRWR > 2.0 due to complications (e.g. hypertension-related stroke, graft dysfunction, death) is not currently supported in infants and stretching DRWR acceptance criteria would decrease PHT waitlist duration and potentially improve waitlist complications and mortality.
目的
由于供体短缺，等待儿科心脏移植（PHT）的婴儿经历了较长的等待时间和较高的死亡率。我们利用美国器官共享网络数据库，探讨增加供体-受者体重比（DRWR）>2.0（推荐的截止值）是否与不良结局相关。
方法
2007 年至 2020 年间，共有 1392 名婴儿接受了 PHT。我们将队列分为 3 组：A 组（DRWR ≤1.0，n=239，17%）、B 组（DRWR 1.0-2.0，n=947，68%）、C 组（DRWR>2.0，n=206，15%）。分析组间特征和 PHT 结局。
结果
DRWR 范围为 0.5 至 4.1。基础病理（先天性与心肌病）、性别、种族、肾功能和机械循环支持在各组间无差异。C 组患者更可能需要呼吸机、接受 ABO 血型不相容的心脏，并且供体缺血时间更长。C 组的等待时间明显缩短（33 天与 50 天，P<0.01）。A、B 和 C 组的早期结局如下（分别为）：手术死亡（6%、4%、3%，P=0.29）、原发性移植物功能障碍（5%、3%、3%，P=0.30）、肾衰竭（10%、7%、7%，P=0.42）和中风（3%、4%、1%，P=0.36）。在先天性心脏病（比值比（OR）=0.819，95%置信区间（CI）=0.523-1.282）或心肌病（OR=1.221，95%CI=0.780-1.912）患者中，DRWR 组与手术死亡均无相关性，唯一显著因素是术前体外膜肺氧合（OR=4.400，95%CI=2.761-7.010）。此外，1 年（87%、87%、85%，P=0.80）和 5 年（76%、78%、77%，P=0.80）的生存率在 DRWR 组之间无差异。
结论
接受 DRWR>2.0 至 4.1 的 PHT 的婴儿等待时间更短，移植相关并发症、手术或晚期死亡率没有明显增加。由于并发症（如高血压相关中风、移植物功能障碍、死亡）而避免 DRWR>2.0 的历史做法在婴儿中目前并不支持，放宽 DRWR 接受标准将缩短 PHT 等待时间，并可能改善等待期间的并发症和死亡率。
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