Canver C C, Luick E K, Friar J A, Mentzer R M
Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine, Madison 53792, USA.
Ann Thorac Surg. 1996 Feb;61(2):635-9. doi: 10.1016/0003-4975(95)00972-8.
Despite a nationwide surplus of cardiac transplantation programs, the number of United States armed forces veterans who receive heart transplants has declined over the past several years. This study reviews the efficacy of a partnership between a Veterans Affairs hospital and a university hospital in maximizing the access of veterans to the limited donor heart supply.
As part of a contract-based sharing agreement between the University of Wisconsin Hospital and the William S. Middleton Memorial Veterans Affairs Hospital, 25 veterans underwent orthotopic heart transplantation between October 1993 and April 1995. Care of the patients was provided at the Veterans Affairs Hospital. The transplantation operations were performed at the University of Wisconsin Hospital, and all patients were transferred back to the Veterans Affairs Hospital 5 to 7 days afterward. All patients were men (mean age, 52.1 +/- 2.1 years) and were referred from Veterans Affairs hospitals in nine different states.
During the 19-month period, the average length of hospital stay for pretransplantation evaluation was 7.0 +/- 0.7 days (range, 2 to 15 days). Average status I waiting time was 26.9 +/- 3.3 days (range, 5 to 54 days); the average waiting time for status II was 115.1 +/- 16 days (range, 15 to 242 days). Posttransplantation length of stay at the Veterans Affairs Hospital was 22 +/- 1.8 days (range, 11 to 41 days). Only 1 patient (4%) experienced a lethal postoperative complication. Ten patients (40%) exhibited graft rejection within the first month after transplantation, requiring treatment with augmented immunosuppressive therapy (steroids, orally in 2 patients and intravenously in 8). The overall 30-day mortality rate was 4% (1 patient). The cause of death was acute grade 4 graft rejection 3 weeks after transplantation. Overall patient survival was 96%.
A partnership between a Veterans Affairs hospital and a university hospital committed to transplantation can increase Veterans Affairs cardiac transplantation activity, with excellent 30-day mortality and early survival results.
尽管全国范围内心脏移植项目供过于求，但在过去几年中，接受心脏移植的美国退伍军人数量有所下降。本研究回顾了一家退伍军人事务医院与一家大学医院之间的合作关系在使退伍军人最大限度地获得有限的供体心脏方面的效果。
作为威斯康星大学医院与威廉·S·米德尔顿纪念退伍军人事务医院之间基于合同的共享协议的一部分，1993年10月至1995年4月期间，25名退伍军人接受了原位心脏移植。患者的护理在退伍军人事务医院提供。移植手术在威斯康星大学医院进行，所有患者在术后5至7天转回退伍军人事务医院。所有患者均为男性（平均年龄52.1±2.1岁），来自九个不同州的退伍军人事务医院。
在19个月期间，移植前评估的平均住院时间为7.0±0.7天（范围2至15天）。I级状态的平均等待时间为26.9±3.3天（范围5至54天）；II级状态的平均等待时间为115.1±16天（范围15至242天）。退伍军人事务医院的移植后住院时间为22±1.8天（范围11至41天）。只有1名患者（4%）出现致命的术后并发症。10名患者（40%）在移植后第一个月内出现移植物排斥反应，需要加强免疫抑制治疗（2名患者口服类固醇，8名患者静脉注射类固醇）。30天总死亡率为4%（1名患者）。死亡原因是移植后3周急性4级移植物排斥反应。总体患者生存率为96%。
退伍军人事务医院与致力于移植的大学医院之间的合作关系可以增加退伍军人事务心脏移植活动，30天死亡率和早期生存结果良好。
