Young J B, Naftel D C, Bourge R C, Kirklin J K, Clemson B S, Porter C B, Rodeheffer R J, Kenzora J L
Cardiac Transplant Research Database Center, University of Alabama at Birmingham.
J Heart Lung Transplant. 1994 May-Jun;13(3):353-64; discussion 364-5.
Little information is available regarding donor-specific parameters that predict success or failure after heart transplantation. Furthermore, with increasing numbers of patients awaiting heart transplantation, there is tremendous pressure to expand the donor pool by stretching the margins of donor acceptability. To gain insight into donor-related and donor-recipient interrelated predictors of death after transplantation, 1719 consecutive primary transplantations performed at 27 institutions between Jan. 1, 1990, and June 30, 1992, were analyzed. Mean follow-up of survivors was 13.9 months, and actuarial survival was 85% at 1 year. By multivariable analysis, risk factors for death included younger recipient age (p = 0.006), older recipient age (p = 0.0005), ventilator support at time of transplantation (p = 0.0006), higher pulmonary vascular resistance (p = 0.02), older donor age (p < 0.0001), smaller donor body surface area (female donor heart placed into larger male patient) (p = 0.003), greater donor inotropic support (p = 0.01), donor diabetes mellitus (p = 0.01), longer ischemic time (p = 0.0003), diffuse donor heart wall motion abnormalities by echocardiography (p = 0.06), and, for pediatric donors, death from causes other than closed head trauma (p = 0.02). The overall 30-day mortality rate was 7% but increased to 11% when donor age exceeded 50 years and was 12% when inotropic support exceeded 20 micrograms/kg/min dopamine plus dobutamine and 22% with diffuse echocardiographic wall motion abnormalities. The interaction of donor risk factors was such that the heart of a smaller female donor given high-dose inotropes placed into a larger male recipient produced a predicted 30-day mortality rate of 26% and the heart of a 25-year-old male donor given high-dose inotropes with diffuse echocardiographic wall motion abnormalities transplanted into a 50-year-old male recipient led to a predicted 30-day mortality rate of 17%. This analysis supports cautious extension of criteria for donor acceptance but with an anticipated greater risk in the presence of diffuse echocardiographic wall motion abnormalities and long anticipated ischemic time, particularly in older donors given inotropic support.
关于预测心脏移植术后成败的供体特异性参数，目前所知信息甚少。此外，随着等待心脏移植的患者数量不断增加，通过放宽供体可接受范围来扩大供体库面临着巨大压力。为深入了解移植后死亡的供体相关及供体 - 受体相关预测因素，对1990年1月1日至1992年6月30日期间在27家机构进行的1719例连续初次移植进行了分析。存活者的平均随访时间为13.9个月，1年时的精算生存率为85%。通过多变量分析，死亡的危险因素包括受体年龄较小（p = 0.006）、受体年龄较大（p = 0.0005）、移植时使用呼吸机支持（p = 0.0006）、肺血管阻力较高（p = 0.02）、供体年龄较大（p < 0.0001）、供体体表面积较小（女性供体心脏植入较大男性患者体内）（p = 0.003）、供体更强的正性肌力支持（p = 0.01）、供体患有糖尿病（p = 0.01）、缺血时间较长（p = 0.0003）以及超声心动图显示供体心脏壁运动弥漫性异常（p = 0.06），对于儿科供体，死于非闭合性颅脑外伤以外的原因（p = 0.02）。总体30天死亡率为7%，但当供体年龄超过50岁时升至11%，当正性肌力支持超过20微克/千克/分钟多巴胺加多巴酚丁胺时为12%，超声心动图显示壁运动弥漫性异常时为22%。供体危险因素之间的相互作用使得将接受高剂量正性肌力药物治疗的较小女性供体的心脏植入较大男性受体体内时，预测的30天死亡率为26%，而将接受高剂量正性肌力药物治疗且超声心动图显示壁运动弥漫性异常的25岁男性供体的心脏移植到50岁男性受体体内时，预测的30天死亡率为17%。该分析支持谨慎放宽供体接受标准，但在超声心动图显示壁运动弥漫性异常和预计缺血时间较长时，尤其是在接受正性肌力支持的老年供体中，预期风险会更大。
