Jeevanandam V, Furukawa S, Prendergast T W, Todd B A, Eisen H J, McClurken J B
Section of Cardiothoracic Surgery, Temple University Health Sciences Center, Philadelphia, Pennsylvania, USA.
Ann Thorac Surg. 1996 Nov;62(5):1268-75. doi: 10.1016/0003-4975(96)00626-1.
The lack of satisfactory donor organs limits heart transplantation. The purpose of this study was to determine whether the criteria for suitability of donors may be safely expanded.
One hundred ninety-six heart transplantations were performed on 192 patients at our institution from January 1992 to 1995 and were divided into two groups. Group A donors (n = 113) conformed to the standard criteria. Group B donors (n = 83) deviated by at least one factor and consisted of the following: 16 hearts from donors greater than 50 years of age, 33 with myocardial dysfunction (echocardiographic ejection fraction = 0.35 +/- 0.10, dopamine level exceeding 20 micrograms.kg-1.min-1, and resuscitation with triiodothyronine), 33 undersized donors with donor to recipient weight ratios of 0.45 +/- 0.04, 48 with extended ischemic times of 297.4 +/- 53.6 minutes, 25 with positive blood cultures, 16 with positive hepatitis C antibody titers, and 7 with conduction abnormalities (Wolff-Parkinson-White syndrome, prolonged QT interval, bifascicular block).
Thirty-day mortality was 6.2% (7/113) in group A and 6.0% (5/83) in group B. Mortality in group A was attributed to 3 patients with myocardial dysfunction, 2 with infection, 1 with acute rejection, and 1 with pancreatitis; group B had 2 with myocardial dysfunction, 1 with infection, 1 with aspiration, and 1 with bowel infarction. At 12 months, survival and hemodynamic indices were similar between the groups. Of the 16 recipients with hepatitis C-positive hearts, 5 have become hepatitis C positive with mild hepatitis (follow up, 6 to 30 months).
Expanding the criteria for suitability of donor hearts dramatically increases the number of transplantations without compromising recipient outcome.
可供移植的心脏器官匮乏限制了心脏移植手术的开展。本研究旨在确定供体心脏的入选标准是否能够安全地扩大范围。
1992年1月至1995年，我们机构为192例患者实施了196例心脏移植手术，并将其分为两组。A组供体（n = 113）符合标准入选标准。B组供体（n = 83）至少在一个因素上不符合标准，包括以下情况：16例供体年龄大于50岁；33例存在心肌功能障碍（超声心动图射血分数 = 0.35±0.10，多巴胺水平超过20μg·kg-1·min-1，并使用三碘甲状腺原氨酸进行复苏）；33例供体心脏过小，供体与受体体重比为0.45±0.04；48例缺血时间延长至297.4±53.6分钟；25例血培养呈阳性；16例丙型肝炎抗体滴度呈阳性；7例存在传导异常（预激综合征、QT间期延长、双分支阻滞）。
A组30天死亡率为6.2%（7/113），B组为6.0%（5/83）。A组死亡原因包括3例心肌功能障碍、2例感染、1例急性排斥反应和1例胰腺炎；B组包括2例心肌功能障碍、1例感染、1例误吸和1例肠梗死。12个月时，两组患者的生存率和血流动力学指标相似。在16例接受丙型肝炎抗体阳性供体心脏移植的患者中，5例已出现丙型肝炎病毒感染且肝炎症状较轻（随访6至30个月）。
扩大供体心脏的入选标准可显著增加心脏移植手术的数量，且不会影响受体的手术效果。
