Nunoda S, Kurosawa R, Kogashi K, Yamagishi S, Mitsui F, Funabashi W
Department of Internal Medicine, Kofu National Hospital, Yamanashi, Japan.
Heart Vessels. 1997;Suppl 12:37-40.
To examine important points surrounding the indications for heart transplantation (HTX) to care after HTX, we reviewed 22 patients with refractory heart failure aged less than 60 years who had been observed for the past 6 years. Sixteen patients had dilated cardiomyopathy; 1, dilated hypertrophic cardiomyopathy; 3, restrictive cardiomyopathy; and 2, ischemic cardiomyopathy; there were 15 males and 7 females, and 6 of the 22 patients were children. The 22 patients were divided into two groups according to their response to tailored medical therapy. Group 1 (n = 6) consisted of those whose cardiac function improved to New York Heart Association (NYHA) status 2 from NYHA status 3 or 4. Group 2 (n = 16) still exhibited refractory heart failure. Seven of these 16 patients went on to have successful HTX. Survival in groups 1 and 2 combined was significantly lower than actuarial survival post-HTX cited in the registry of the International Society for Heart and Lung Transplantation, and group 2 had an even lower survival than the total groups 1 and 2 survival. Survival in children was much lower than that in adults. Seven of the 16 patients in group 2 showed a genetic link, but there was no genetic link in group 1 patients. One patient in group 2 had a panel reactive antibody (PRA) value of 46% and died while awaiting HTX. Post-HTX care in terms of immunosuppressant therapy, was modified for each patient. It is particularly necessary to consider the time a patient will wait on the list for candidates for HTX who are children, have a genetic link, or are positive for PRA. A genetic approach is helpful to determine indications for HTX. Sensitive monitoring of post-HTX immunosuppression is needed.
为了研究心脏移植（HTX）的适应证及HTX术后护理等要点，我们回顾了过去6年中观察的22例年龄小于60岁的难治性心力衰竭患者。16例为扩张型心肌病；1例为扩张型肥厚型心肌病；3例为限制型心肌病；2例为缺血性心肌病；其中男性15例，女性7例，22例患者中有6例为儿童。根据对个体化药物治疗的反应，将22例患者分为两组。第1组（n = 6）由心功能从纽约心脏协会（NYHA）3级或4级改善至2级的患者组成。第2组（n = 16）仍表现为难治性心力衰竭。这16例患者中有7例成功进行了HTX。第1组和第2组合并后的生存率显著低于国际心肺移植学会登记处引用的HTX术后预期生存率，且第2组的生存率甚至低于第1组和第2组的总生存率。儿童的生存率远低于成人。第2组的16例患者中有7例显示出遗传关联，但第1组患者中无遗传关联。第2组中有1例患者的群体反应性抗体（PRA）值为46%，在等待HTX期间死亡。针对每位患者调整了HTX术后免疫抑制治疗方面的护理。对于儿童、有遗传关联或PRA呈阳性的HTX候选患者，尤其有必要考虑其在等待名单上的时间。基因方法有助于确定HTX的适应证。需要对HTX术后免疫抑制进行敏感监测。
