Michler R E, McLaughlin M J, Chen J M, Geimen R, Schenkel F, Smith C R, Barr M L, Rose E A
Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, Columbia University College of Physicians & Surgeons, New York, NY.
J Thorac Cardiovasc Surg. 1993 Oct;106(4):622-9; discussion 629-31.
Although more than 560 patients worldwide have undergone cardiac retransplantation, few studies of this population have been reported. To evaluate the risk of cardiac retransplantation and to better establish selection criteria, we reviewed the records of all patients who underwent retransplantation at the Columbia-Presbyterian Medical Center. Of 431 patients who underwent transplantation between February 1977 and March 1991, 408 underwent the procedure in the era of cyclosporine-based immunosuppression. Thirteen of these 408 patients underwent retransplantation (including one patient who received a third graft). Indications for the 14 retransplantations included transplant coronary artery disease (n = 8), rejection (n = 5), and intraoperative graft failure (n = 1). Immunosuppression and follow-up protocols used in this cohort were similar to those in the primary transplantation population. No significant differences were found in either actuarial survival between primary transplant recipients (75.1% +/- 2.2% at 1 year and 71.3% +/- 2.4% at 2 years) and patients who underwent retransplantation (71.4% +/- 12.1% at 1 year and 59.5% +/- 14.8% at 2 years) or in linearized rates of rejection and actuarial freedom from rejection between the two groups. No differences between these groups were found with regard to age, sex, race, origin of end-stage heart disease, or early (< 30 day) mortality. The origin of primary graft failure did not correlate with survival outcome in the retransplantation cohort. Follow-up time for patients having primary transplantation ranged from 0 to 8 years (mean 24 months) with a cumulative patient follow-up of 830 patient-years; follow-up time for patients who underwent retransplantation ranged from 0 to 3 years (mean 8.1 months) with a cumulative patient follow-up of 9.5 patient-years. Approximately 50% of patients in both groups had at least one rejection episode by 3 months. Within the limited time period studied after retransplantation, only one patient had transplant coronary artery disease, approximately 27 months after her first retransplantation procedure for acute rejection. These results indicate that the prognosis for patients undergoing cardiac retransplantation is good for patients for whom the indication for retransplantation is identified more than 30 days after initial transplantation.
尽管全球已有560多名患者接受了心脏再次移植，但针对这一群体的研究报道较少。为了评估心脏再次移植的风险并更好地制定选择标准，我们回顾了在哥伦比亚长老会医学中心接受再次移植的所有患者的记录。在1977年2月至1991年3月期间接受移植的431例患者中，408例是在基于环孢素的免疫抑制时代接受手术的。这408例患者中有13例接受了再次移植（包括1例接受第三次移植的患者）。14次再次移植的指征包括移植冠状动脉疾病（n = 8）、排斥反应（n = 5）和术中移植物功能衰竭（n = 1）。该队列中使用的免疫抑制和随访方案与初次移植人群相似。初次移植受者（1年时为75.1%±2.2%，2年时为71.3%±2.4%）和接受再次移植的患者（1年时为71.4%±12.1%，2年时为59.5%±14.8%）的精算生存率，以及两组之间的排斥反应线性化率和精算无排斥生存率均未发现显著差异。两组在年龄、性别、种族、终末期心脏病的起源或早期（<30天）死亡率方面均未发现差异。初次移植物功能衰竭的起源与再次移植队列中的生存结果无关。初次移植患者的随访时间为0至八年（平均24个月），累积患者随访时间为830患者年；接受再次移植的患者随访时间为0至三年（平均8.1个月），累积患者随访时间为9.5患者年。两组中约50%的患者在3个月时至少有一次排斥反应发作。在再次移植后的有限研究时间段内，只有一名患者在首次因急性排斥反应进行再次移植手术后约27个月出现了移植冠状动脉疾病。这些结果表明，对于初次移植后30天以上确定再次移植指征的患者，心脏再次移植的预后良好。
