Sarris G E, Moore K A, Schroeder J S, Hunt S A, Fowler M B, Valantine H B, Vagelos R H, Billingham M E, Oyer P E, Stinson E B
Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA 94305.
J Thorac Cardiovasc Surg. 1994 Aug;108(2):240-51; discussion 251-2.
We analyzed our experience with 496 patients who underwent primary cardiac transplantation since the introduction of cyclosporine immunosuppression (Dec. 16, 1980, to Jan. 7, 1993). There were 388 male and 108 female patients. Mean recipient age was 40 +/- 16 years (range 0.1 to 70 years, median 44 years). Recipient diagnoses included coronary disease in 188, idiopathic cardiomyopathy in 196, viral cardiomyopathy in 35, and congenital heart disease in 28 patients. Donor age was 25 +/- 10 years (range 1 to 53 years, median 24 years). Graft ischemic time was 148 +/- 57 minutes (range 38 to 495 minutes, median 149 minutes). Operative mortality (hospital death) rate was 7.9% +/- 1.3% (70% confidence intervals). Multivariate logistic regression analysis revealed that (higher) pulmonary vascular resistance and gender (female) were the only independent predictors of hospital death (p < 0.05). Actuarial survival estimates for all patients at 1, 5, and 10 years are 82% +/- 1.7% (83% +/- 1.8% adult, 77% +/- 5.2% pediatric), 61% +/- 2.5% (65% +/- 2.5% adult, 64% +/- 6.6% pediatric), and 41% +/- 3.7% (40% +/- 4% adult, 54% +/- 8.6% pediatric), respectively. For 232 patients treated with triple-drug immunosuppression and induction with OKT3 since 1987, survival estimates at 1 and 5 years are 82% +/- 2.6% and 67% +/- 3.7%, respectively. Causes of death for the entire group were rejection in 29 (14% of deaths), infection in 69 (34%), graft coronary disease in 36 (18%), nonspecific graft failure in 6 (3%), malignancy in 19 (10%), stroke in 6 (3%), pulmonary hypertension in 6 (3%), and other causes in 30 (15%) patients. Actuarial freedom from rejection at 3 months, 1 year, and 5 years was 21% +/- 1.9%, 14% +/- 1.7%, and 7.2% +/- 1.5%, respectively (+/- 1 standard error of the mean). Estimates of freedom from rejection-related death at 1, 5, and 10 years were 96% +/- 1%, 93% +/- 1.4%, and 93% +/- 1.4%, respectively. Actuarial freedom from any infection at 3 months and at 1 and 5 years was 40% +/- 2.3%, 27% +/- 2.1%, and 15% +/- 2.0% and from infection-related death, 95% +/- 1.0%, 93% +/- 1.2%, and 85% +/- 1.9%, respectively. Actuarial freedom from (angiographic or autopsy proved) graft coronary artery disease at 1, 5, and 10 years was 95% +/- 1.2%, 73% +/- 2.7%, and 65% +/- 3.6% and from coronary disease-related death or retransplantation 98% +/- 0.7%, 84% +/- 2.2%, and 66% +/- 4.3%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
我们分析了自环孢素免疫抑制疗法应用以来（1980年12月16日至1993年1月7日）496例行原位心脏移植患者的经验。其中男性患者388例，女性患者108例。受者平均年龄为40±16岁（范围0.1至70岁，中位数44岁）。受者诊断包括冠心病188例、特发性心肌病196例、病毒性心肌病35例、先天性心脏病28例。供者年龄为25±10岁（范围1至53岁，中位数24岁）。移植物缺血时间为148±57分钟（范围38至495分钟，中位数149分钟）。手术死亡率（院内死亡）为7.9%±1.3%（70%可信区间）。多因素逻辑回归分析显示，（较高的）肺血管阻力和性别（女性）是院内死亡的仅有的独立预测因素（p<0.05）。所有患者1年、5年和10年的精算生存率估计分别为82%±1.7%（成人83%±1.8%，儿童77%±5.2%）、61%±2.5%（成人65%±2.5%，儿童64%±6.6%）和41%±3.7%（成人40%±4%，儿童54%±8.6%）。自1987年以来，232例接受三联药物免疫抑制并用OKT3诱导治疗的患者，1年和5年的生存估计分别为82%±2.6%和67%±3.7%。整个组的死亡原因包括排斥反应29例（占死亡的14%）、感染69例（34%）、移植物冠心病36例（18%）、非特异性移植物衰竭6例（3%）、恶性肿瘤19例（10%）、中风6例（3%）、肺动脉高压6例（3%）以及其他原因30例（15%）。3个月、1年和5年的精算无排斥反应率分别为21%±1.9%、14%±1.7%和7.2%±1.5%（±平均标准误）。1年、5年和10年的无排斥反应相关死亡率估计分别为96%±1%、93%±1.4%和93%±1.4%。3个月、1年和5年的精算无任何感染率分别为40%±2.3%、27%±2.1%和15%±2.0%，无感染相关死亡率分别为95%±1.0%、93%±1.2%和85%±1.9%。1年、5年和10年的精算无（血管造影或尸检证实的）移植物冠状动脉疾病率分别为95%±1.2%、73%±2.7%和65%±3.6%，无冠心病相关死亡或再次移植率分别为98%±0.7%、84%±2.2%和66%±4.3%。（摘要截短至400字）
