Bennett L E, Edwards E B, Hosenpud J D
Joint ISHLT/UNOS Thoracic Registry, Richmond, VA, USA.
J Heart Lung Transplant. 1998 Sep;17(9):901-5.
We have previously demonstrated that the use of older donor hearts (>45 years) increases the odds of death nearly twofold in the early posttransplantation period when compared with the use of hearts from younger donors. Before excluding this segment of the donor pool, however, the mortality risk for remaining on the waiting list compared with that of receiving an older donor heart should also be considered.
We examined all adult status 2 patients added to the United Network for Organ Sharing heart transplant waiting list for primary transplantation between 1992 and 1995 (n = 4681). To account for the transient increased risk after transplantation, we used a time-dependent nonproportional hazards model with an exponential decay component for the analysis. For patients with an equal time since listing, the resulting risk ratios represent the ratio of mortality risk for a patient who receives an older donor heart to the mortality risk for a patient who remains on the waiting list.
After 30 days posttransplantation, the risk of death for recipients of 45- to 49-year-old donor hearts was lower than if they had remained on the waiting list, and by 6 months the relative risk was 0.37 (95% confidence interval: 0.22, 0.62). For recipients of hearts from donors 50 years or older, the risk after transplantation was lower after 64 days, and by 6 months the relative risk was 0.48 (95% confidence interval: 0.31, 0.75).
These results suggest that in spite of a high initial risk resulting from the transplant procedure, there was a clear long-term survival benefit for status 2 recipients of older donor hearts. Thus overall, in spite of the increased risk of death associated with receiving older donor hearts, the risk of death without a transplant was even greater. On the basis of this analysis we cannot support the exclusion of older donors from the donor pool.
我们之前已经证明，与使用年轻供体的心脏相比，使用年龄较大（>45岁）的供体心脏会使移植后早期死亡几率增加近两倍。然而，在排除这部分供体库之前，还应考虑与接受年龄较大供体心脏相比，留在等待名单上的死亡风险。
我们研究了1992年至1995年间加入器官共享联合网络心脏移植等待名单进行初次移植的所有成年2级患者（n = 4681）。为了考虑移植后短暂增加的风险，我们使用了具有指数衰减成分的时间依赖性非比例风险模型进行分析。对于自列入名单后时间相同的患者，得出的风险比代表接受年龄较大供体心脏的患者的死亡风险与留在等待名单上的患者的死亡风险之比。
移植后30天，接受45至49岁供体心脏的受者的死亡风险低于他们留在等待名单上的情况，到6个月时相对风险为0.37（95%置信区间：0.22，0.62）。对于接受50岁及以上供体心脏的受者，移植后64天后风险较低，到6个月时相对风险为0.48（95%置信区间：0.31，0.75）。
这些结果表明，尽管移植手术最初风险较高，但对于2级老年供体心脏受者有明显的长期生存益处。因此总体而言，尽管接受老年供体心脏会增加死亡风险，但不进行移植的死亡风险甚至更高。基于此分析，我们不支持将老年供体排除在供体库之外。
