Drinkwater D C, Laks H, Blitz A, Kobashigawa J, Sabad A, Moriguchi J, Hamilton M
Division of Cardiothoracic Surgery, University of California, Los Angeles, USA.
J Heart Lung Transplant. 1996 Jul;15(7):684-91.
The limited number of donor hearts relative to the number of waiting recipients is the major determinate of a growing inequity. Although a number of potential options are being vigorously pursued, the most effective immediate solution is to expand acceptance criteria for donor age and medical condition. This report is a review of our early and late results with the use of older donors, including simultaneously "bypassed" donor hearts.
Between April 1987 and September 1994, 52 patients received older donor hearts (older than 45 years) with a mean donor age of 51 years. Ten patients in this group received hearts simultaneously bypassed with from 1 to 4 grafts per patient. Donor and recipient age, diagnosis, and HLA match were compared between the older donor group and a contemporaneous younger (younger than 45) donor group (N = 324). Also compared was actuarial survival at up to 5 years of follow-up in addition to graft function, bypass graft patency, infection and rejection incidence at 1 year, and the prevalence of transplant-associated coronary artery disease in the two groups. Echocardiography, coronary angiography, and intravascular coronary ultrasonography were used for this assessment.
One-year actuarial survival was 84% for the older donor group, which included 19 status 1 patients (survival 76%) and 23 status II patients (survival 90%). In the bypassed donor subgroup there was a 60% 1-year actuarial survival with 5 status 1 patients (survival 80%) and 5 status II patients (survival 40%). At 1 year, left ventricular function and the incidence of infection and rejection were equal between these two donor groups. Five-year actuarial survivals were the same between the overall older and younger donor groups. Finally, the development of transplant-associated coronary disease was similar in both groups up to 5 years after transplantation.
This initial review of heart transplantation with older donor hearts, including bypassed hearts, demonstrates similar early and late survival outcomes as compared with those of a contemporaneous younger donor group. Significantly, there appears to be no difference in the development of transplant-associated coronary artery disease during the follow-up period. The older donor represents a potential immediate increase in the number of suitable hearts for transplantation. Bypassed donor hearts represent a small but potentially significant subgroup that may be safely and effectively used when appropriately matched to the recipient by age and medical condition. Greater experience, particularly with this bypassed group, will help determine optimal donor-to-recipient matching for the future.
供体心脏数量相对于等待移植受体数量的有限性是导致不公平现象日益严重的主要决定因素。尽管目前正在大力探索多种潜在的解决办法，但最有效的即时解决方案是扩大对供体年龄和身体状况的接受标准。本报告回顾了我们使用老年供体心脏（包括同时被“旁路化”的供体心脏）的早期和晚期结果。
1987年4月至1994年9月期间，52例患者接受了老年供体心脏（年龄超过45岁），供体平均年龄为51岁。该组中有10例患者接受了同时被旁路化的心脏，每位患者有1至4支移植血管。将老年供体组与同期的年轻（年龄小于45岁）供体组（N = 324）进行供体和受体年龄、诊断及人类白细胞抗原匹配情况的比较。此外，还比较了两组在长达5年随访期的精算生存率、移植心脏功能、旁路移植血管通畅率、1年时的感染和排斥发生率以及移植相关冠状动脉疾病的患病率。使用超声心动图、冠状动脉造影和血管内冠状动脉超声进行此项评估。
老年供体组1年精算生存率为84%，其中包括19例1级患者（生存率76%）和23例2级患者（生存率90%）。在被旁路化的供体亚组中，1年精算生存率为60%，其中5例1级患者（生存率80%）和5例2级患者（生存率40%）。1年时，这两个供体组的左心室功能以及感染和排斥发生率相当。总体老年和年轻供体组的5年精算生存率相同。最后，两组在移植后长达5年的时间里，移植相关冠状动脉疾病的发展情况相似。
对使用老年供体心脏（包括被旁路化的心脏）进行心脏移植的这一初步回顾表明，与同期年轻供体组相比，其早期和晚期生存结果相似。重要的是，在随访期间，移植相关冠状动脉疾病的发展似乎没有差异。老年供体代表了可用于移植的合适心脏数量的潜在即时增加。被旁路化的供体心脏代表了一个小但可能具有重要意义的亚组，当按年龄和身体状况与受体适当匹配时，可安全有效地使用。更多的经验，特别是针对这个被旁路化的组，将有助于确定未来供体与受体的最佳匹配。
