McGiffin D C, Kirklin J K, Naftel D C, Bourge R C
Department of Surgery, University of Alabama at Birmingham 35294-0007, USA.
J Heart Lung Transplant. 1997 Feb;16(2):190-8.
To understand the time relatedness of the various causes of death after heart transplantation, a study was undertaken to examine the relative importance of each of these causes of death across time, as well as between eras. The analysis, which was in the competing outcomes domain, involved 326 patients undergoing primary heart transplantation between November 1981 and June 1994, of which 122 patients died. Two eras were considered--an earlier era (1981 to 1986) and a later era (1987 to 1994). During the later era, the estimated survival rate at 1 year and 5 years was 85% and 69%, respectively. During the first posttransplantation year, patients in the earlier era were three times more likely to die of early graft failure than in the later era, but the difference may have been due to chance (p > 0.2). During the first posttransplantation year, patients were three times as likely to die of acute rejection in the earlier era (p = 0.02). Patients surviving 3 or more years in both eras had a similar (approximately 3%) likelihood of death from coronary artery disease over the ensuing 4 years. In the later era, the risk of dying of malignancy (2.5%), infection (3.2%), or miscellaneous other causes (4.1%) was as likely after 3 years as dying of coronary artery disease (3.2%). Competing outcomes analysis is a useful means of portraying the distribution of multiple time-related causes of death. In the current era, the deleterious long-term effects of immunosuppression (malignancy and infection), as well as coronary artery disease, threaten long-term survival.
为了解心脏移植后各种死因的时间相关性，开展了一项研究，以考察这些死因在不同时间以及不同时期的相对重要性。该分析属于竞争结局领域，涉及1981年11月至1994年6月期间接受首次心脏移植的326例患者，其中122例患者死亡。研究考虑了两个时期——早期（1981年至1986年）和后期（1987年至1994年）。在后期，1年和5年的估计生存率分别为85%和69%。在移植后的第一年，早期的患者死于早期移植物功能衰竭的可能性是后期患者的三倍，但这种差异可能是偶然因素导致的（p>0.2）。在移植后的第一年，早期患者死于急性排斥反应的可能性是后期患者的三倍（p=0.02）。在两个时期存活3年或更长时间的患者，在随后4年中死于冠状动脉疾病的可能性相似（约3%）。在后期，3年后死于恶性肿瘤（2.5%）、感染（3.2%）或其他各种原因（4.1%）的风险与死于冠状动脉疾病（3.2%）的风险相当。竞争结局分析是描述多种时间相关死因分布的一种有用方法。在当前时代，免疫抑制的有害长期影响（恶性肿瘤和感染）以及冠状动脉疾病威胁着长期生存。
