Kirsch M, Baufreton C, Naftel D C, Benvenuti C, Loisance D Y
Department of Thoracic and Cardiovascular Surgery, Hôpital Henri Mondor, Créteil, France.
J Heart Lung Transplant. 1998 Mar;17(3):268-77.
Risk factors for death after primary heart transplantation were identified by analyzing our total experience with 234 patients who underwent transplantation at our institution from May 28, 1979, to May 27, 1996.
There were 205 male and 29 female patients. Mean recipient age was 48.5+/-10.9 years (standard deviation). Recipient diagnosis included ischemic cardiomyopathy in 103 (44%), idiopathic cardiomyopathy in 98 (42%), valvular heart disease in 17 (7%), congenital heart disease in 4 (2%), and other diagnoses in 12 (5%) patients. Donor age was 32+/-10.2 years. Graft ischemic time was 138.1+/-51.8 minutes. The operative mortality rate was 23.5%. Actuarial survival estimates for all patients at 1, 5, and 10 years were 62%, 50%, and 44%, respectively. The three most common causes of death (both early and late) after primary heart transplantation were infection (27.4%), acute rejection (18.9%), and early graft failure (17.9%). Multivariate logistic regression analysis identified older recipient age (p = 0.007), higher preoperative pulmonary vascular resistance (p = 0.01), recipient preoperative hepatic insufficiency (p = 0.001), and gender mismatch (p = 0.02) as independent predictors of early death (within 3 months of the procedure). Multivariate proportional hazard regression analysis revealed that recipient idiopathic cardiomyopathy (p = 0.02) and recipient preoperative liver failure (p = 0.01) were independent risk factors for late death (after 3 months).
These results underscore the importance of adequate recipient selection and recipient/donor matching for short- and long-term survival after primary heart transplantation.
通过分析1979年5月28日至1996年5月27日在我院接受心脏移植的234例患者的全部经验，确定了心脏原位移植术后死亡的危险因素。
男性患者205例，女性患者29例。受者平均年龄为48.5±10.9岁（标准差）。受者诊断包括缺血性心肌病103例（44%）、特发性心肌病98例（42%）、瓣膜性心脏病17例（7%）、先天性心脏病4例（2%）以及其他诊断12例（5%）。供者年龄为32±10.2岁。移植物缺血时间为138.1±51.8分钟。手术死亡率为23.5%。所有患者1年、5年和10年的精算生存率分别为62%、50%和44%。心脏原位移植术后（早期和晚期）最常见的三种死亡原因是感染（27.4%）、急性排斥反应（18.9%）和早期移植物功能衰竭（17.9%）。多因素逻辑回归分析确定，受者年龄较大（p = 0.007）、术前肺血管阻力较高（p = 0.01）、受者术前肝功能不全（p = 0.001）以及性别不匹配（p = 0.02）是早期死亡（术后3个月内）的独立预测因素。多因素比例风险回归分析显示，受者特发性心肌病（p = 0.02）和受者术前肝功能衰竭（p = 0.01）是晚期死亡（术后3个月后）的独立危险因素。
这些结果强调了在心脏原位移植术后短期和长期生存中，进行充分的受者选择以及受者/供者匹配的重要性。
