Razzouk A J, Chinnock R E, Dearani J A, Gundry S R, Bailey L L
Department of Surgery, Loma Linda University Medical Center and Children's Hospital, Calif 92354, USA.
Arch Surg. 1998 Aug;133(8):881-5. doi: 10.1001/archsurg.133.8.881.
Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx.
To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children.
A 12-year retrospective cohort review.
A university-affiliated children's hospital.
All infants and children who underwent CTx (group 1, n = 322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx.
Cardiac re-Tx at a mean (+/- SD) interval from the first CTx of 6.3 +/- 1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx.
When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0% vs 8.3%; P = .9), rejection rate (0.98 vs 0.86; P = .1), and hospital stay (23.0 +/- 18.8 days vs 20.5 +/- 11.6 days; P = .65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3% vs 83.3% (P = .59) and 74.4% vs 83.3% (P = .85), respectively.
The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re-Tx.
心脏移植（CTx）已被确立为治疗婴幼儿各种无法手术的心脏疾病的有效方法。然而，移植血管病变（GV）已成为限制CTx受者长期存活的主要因素。严重GV的唯一治疗方法是再次心脏移植（再次Tx）。对于将稀缺的供体器官用于再次心脏移植存在争议。
比较儿童GV再次心脏移植与初次CTx的结果。
一项为期12年的回顾性队列研究。
一家大学附属医院。
所有接受CTx的婴幼儿（第1组，n = 322）有1389.7患者年的完整随访。32例受者确诊有移植血管病变（CTx后1.1 - 8.2年）。13例患者突然死亡，3例在等待再次心脏移植时死亡（重新登记后1 - 17天），4例等待再次心脏移植，12例（第2组）接受了再次心脏移植。
再次心脏移植距首次CTx的平均（±标准差）间隔时间为6.3±1.8年（范围2.2 - 9.4年）。2例患者再次心脏移植时需要额外进行主动脉弓动脉瘤修复。
第1组与第2组比较，手术死亡率（9.0%对8.3%；P = 0.9）、排斥率（0.98对0.86；P = 0.1）和住院时间（23.0±18.8天对20.5±11.6天；P = 0.65）无显著差异。第1组和第2组1年和4年的精算生存率分别为84.3%对83.3%（P = 0.59）和74.4%对83.3%（P = 0.85）。
GV再次心脏移植与初次CTx的手术结果和中期生存率相似。患有严重心脏GV的儿童有猝死风险，早期再次心脏移植可能使其受益。
