Schweitzer E J, Anderson L, Kuo P C, Johnson L B, Klassen D K, Hoehn-Saric E, Weir M R, Bartlett S T
Department of Surgery, University of Maryland School of Medicine, Baltimore 21201, USA.
Transplantation. 1997 May 15;63(9):1294-9. doi: 10.1097/00007890-199705150-00017.
This study was conducted to determine the risk of clinically significant posttransplant cardiac events (PCEs) in a cohort of diabetic patients referred for pancreas transplantation.
Between April 1991 and December 1995, 316 insulin-dependent diabetics were evaluated for pancreas transplantation. Patients were assessed for risk factors for coronary artery disease (CAD), and underwent screening for significant CAD by a standardized algorithm that included selective coronary angiography. For the 3-year period following transplantation, PCEs were identified, and related to pretransplant cardiac risk factors.
Only four patients (1.3%) were turned down for cardiac contraindications. Coronary angiography was done in 74 patients (27% of the active transplant candidates) during the evaluation period because of the patient's history or a positive stress test. Significant coronary artery stenoses were found in 54% of the patients catheterized. Twenty-five of these 40 patients (63%) underwent revascularization with percutaneous transluminal coronary angioplasty and/or coronary artery bypass grafting. A total of 359 organs were subsequently transplanted into 194 of these patients. No deaths occurred within 30 days of any of the transplants; four percent of transplant recipients died of cardiac causes within the follow-up period (median 23 months). Those with no pretransplant evidence of CAD had significantly lower rates of PCE (2% and 8% at 1 and 3 years, respectively) than those with pretransplant evidence of CAD (11% and 29% at 1 and 3 years, P<0.01; relative risk, 4.3).
Routine cardiac screening of pancreas recipients with selective angiography and revascularization allows patients with significant CAD to safely undergo pancreas transplantation. Patients should rarely be excluded from pancreas transplantation for cardiac causes.
本研究旨在确定一组接受胰腺移植的糖尿病患者发生具有临床意义的移植后心脏事件（PCE）的风险。
在1991年4月至1995年12月期间，对316例胰岛素依赖型糖尿病患者进行了胰腺移植评估。对患者进行冠状动脉疾病（CAD）危险因素评估，并通过包括选择性冠状动脉造影在内的标准化算法对严重CAD进行筛查。在移植后的3年期间，确定PCE，并将其与移植前心脏危险因素相关联。
仅4例患者（1.3%）因心脏禁忌证而被拒绝。在评估期间，74例患者（占活跃移植候选者的27%）因患者病史或应激试验阳性而接受了冠状动脉造影。在接受导管检查的患者中，54%发现有明显的冠状动脉狭窄。这40例患者中有25例（63%）接受了经皮腔内冠状动脉成形术和/或冠状动脉旁路移植术进行血运重建。随后，共359个器官被移植到其中194例患者体内。任何一次移植后30天内均未发生死亡；4%的移植受者在随访期间死于心脏原因（中位时间23个月）。移植前无CAD证据的患者PCE发生率（1年和3年分别为2%和8%）明显低于移植前有CAD证据的患者（1年和3年分别为11%和29%，P<0.01；相对风险为4.3）。
通过选择性血管造影和血运重建对胰腺移植受者进行常规心脏筛查，可使患有严重CAD的患者安全地接受胰腺移植。因心脏原因而很少应将患者排除在胰腺移植之外。
