Smith J A, Roberts M, McNeil K, Sharples L D, Schofield P M, Large S R, Nashef S A, Wells F C, Wallwork J
Transplant Unit, Papworth Hospital, Cambridge, UK.
Eur J Cardiothorac Surg. 1996;10(8):628-33. doi: 10.1016/s1010-7940(96)80377-0.
Domino cardiac transplantation affords flexible and optimal organ utilization, provides hearts unaffected by brain death, allows prospective tissue matching, and subsequent transplantation with short allograft ischemic times. A retrospective review of our experience with domino cardiac transplantation has been made.
Seventy-two of 119 patients who underwent heart-lung transplantation from 1988 on served as domino cardiac donors (40 males, 32 females; mean age of 32 years; mean weight of 51 kg). The domino donor diagnoses were cystic fibrosis (n = 47), bronchiectasis (n = 9), primary pulmonary hypertension (n = 6), emphysema (n = 7), pulmonary fibrosis (n = 2) and Eisenmenger's syndrome (n = 1). Forty-seven domino hearts were transplanted at our institution and 25 were exported to other centres in the United Kingdom. The 72 domino cardiac recipients were 62 males and 10 females, mean age of 47 years, mean weight of 60 kg, with ischemic heart disease (n = 32), cardiomyopathy (n = 36) and other conditions (n = 4).
There were four deaths (5.6%) at less than 30 days (2 from multiple organ failure, 1 from primary allograft failure and 1 from acute rejection). Actuarial survival estimates and 1 and 5 years were 77 +/- 5.2% nd 69 +/- 6.3%, respectively. This compared favourably with survival data obtained in 234 non-domino cardiac recipients. In the patients transplanted at Papworth, there was no difference in the incidence of rejection (0.6 +/- 0.05 versus 0.7 +/- 0.03 events per 100 patient days for the first 12 months) or in the freedom from graft atherosclerosis (74 +/- 3% versus 70 +/- 3% at 5 years) between the domino and non-domino groups.
The use of domino hearts donated by recipients of heart-lung transplants is beneficial and is associated with an excellent early and longer-term outcome.
多米诺心脏移植可实现灵活且优化的器官利用，提供不受脑死亡影响的心脏，允许进行前瞻性组织配型，并能在短的移植心脏缺血时间后进行移植。我们对多米诺心脏移植经验进行了回顾性分析。
1988年起接受心肺移植的119例患者中有72例作为多米诺心脏供体（男性40例，女性32例；平均年龄32岁；平均体重51千克）。多米诺供体的诊断包括囊性纤维化（n = 47）、支气管扩张症（n = 9）、原发性肺动脉高压（n = 6）、肺气肿（n = 7）、肺纤维化（n = 2）和艾森曼格综合征（n = 1）。47颗多米诺心脏在我们机构进行了移植，25颗出口到英国其他中心。72例多米诺心脏受体中男性62例，女性10例，平均年龄47岁，平均体重60千克，患有缺血性心脏病（n = 32）、心肌病（n = 36）及其他病症（n = 4）。
30天内有4例死亡（5.6%）（2例死于多器官功能衰竭，1例死于原发性移植心脏衰竭，1例死于急性排斥反应）。1年和5年的精算生存率估计分别为77±5.2%和69±6.3%。这与234例非多米诺心脏受体的生存数据相比更具优势。在帕普沃思医院接受移植的患者中，多米诺组和非多米诺组在排斥反应发生率（前12个月每100患者日分别为0.6±0.05次和0.7±0.0三次事件）或无移植心脏动脉粥样硬化发生率（5年时分别为74±3%和70±3%）方面无差异。
使用心肺移植受体捐献的多米诺心脏是有益的，且与良好的早期及长期结果相关。
