Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Clin Transplant. 2024 Jun;38(6):e15369. doi: 10.1111/ctr.15369.
While stroke is a well-recognized complication of isolated heart transplantation, stroke in patients undergoing simultaneous heart-liver (HLT) and heart-kidney transplantation (HKT) has not been explored. This study assessed postoperative stroke incidence, risk factors, and outcomes in HLT and HKT compared with isolated heart transplant.
The United Network for Organ Sharing database was queried for adult patients undergoing HLT, HKT, and isolated heart transplants between 1994 and 2022. Patients were stratified by presence of in-hospital stroke after transplant. Post-transplant survival at 1-year was assessed using Kaplan-Meier analysis and log-rank tests. Separate multivariable logistic regression models were constructed to identify risk factors for stroke after HKT and HLT.
Of 2326 HKT recipients, 85 experienced stroke, and of 442 HLT recipients, 19 experienced stroke. Stroke was more common after HKT and HLT than after an isolated heart transplant (3.7% vs. 4.3% vs. 2.9%, p = 0.01). One-year post-transplant survival was lower in those with stroke among both HKT recipients (64.5% vs. 88.7%, p(log-rank) < 0.001) and HLT recipients (43.8% vs. 87.4%, p(log-rank) < 0.001. Pre-transplant pVAD, prior stroke, postoperative dialysis, diabetes, prior cardiac surgery, and heart cold ischemic time were independent risk factors for stroke after HKT, after adjusting for age, sex, and need for blood transfusion on the waitlist. For HLT, postoperative dialysis was a significant risk factor.
Stroke is more common after HKT and HLT than after isolated heart transplant, and results in poor survival. Independent risk factors for stroke include pre-transplant percutaneous VAD (HKT) and postoperative dialysis (HKT and HLT).
虽然中风是心脏移植术后一种公认的并发症，但同时进行心脏-肝脏（HLT）和心脏-肾脏（HKT）移植的患者中风尚未被研究。本研究评估了与单纯心脏移植相比，HLT 和 HKT 术后中风的发生率、危险因素和结局。
利用美国器官共享网络数据库，检索 1994 年至 2022 年间成人患者进行 HLT、HKT 和单纯心脏移植的数据。根据移植后是否发生院内中风对患者进行分层。采用 Kaplan-Meier 分析和对数秩检验评估移植后 1 年的生存情况。使用多变量逻辑回归模型分别构建 HKT 和 HLT 后中风的危险因素模型。
在 2326 例 HKT 受者中，85 例发生中风，在 442 例 HLT 受者中，19 例发生中风。与单纯心脏移植相比，HKT 和 HLT 后中风更常见（3.7%比 4.3%比 2.9%，p=0.01）。在 HKT 受者（64.5%比 88.7%，p（对数秩）<0.001）和 HLT 受者（43.8%比 87.4%，p（对数秩）<0.001）中，发生中风的患者移植后 1 年生存率较低。在 HKT 受者中，移植前经皮心室辅助装置（pVAD）、既往中风、术后透析、糖尿病、既往心脏手术和心脏冷缺血时间是中风的独立危险因素，而在 HLT 受者中，术后透析是显著的危险因素。
与单纯心脏移植相比，HKT 和 HLT 后中风更常见，且生存结果较差。中风的独立危险因素包括移植前经皮 VAD（HKT）和术后透析（HKT 和 HLT）。
