Tenderich G, Koerner M M, Stuettgen B, Arusoglu L, Bairaktaris A, Hornik L, Wlost S, Mirow N, Minami K, Koerfer R
Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Transplantation. 1998 Oct 27;66(8):1109-13. doi: 10.1097/00007890-199810270-00025.
Heart transplantation (HT) has become a therapeutic option for patients suffering from endstage heart failure. The increasing demand for cardiac allografts has led to a shift toward extended donor criteria. In a retrospective analysis of 859 HT recipients, we report on the hemodynamic outcome of 19 HT patients who received cardiac allografts from donors > or =60 years of age.
From March 1989 to December 1997, we performed 883 orthotopic HT in 74 children and 809 adults at our transplant center. Within this period, 19 patients (17 women and 2 men) received cardiac allografts from donors > or =60 years of age. Recipient age ranged from 57 to 78 years (mean, 65+/-5 years).
HT could be performed successfully in 19 cases. The early mortality rate was 16% (n=3). The late mortality rate was 37% (n=7). All long-term survivors are stable at New York Heart Association classification II (New York Heart Association Class II = resting hemodynamics: cardiac output normal; left ventricular end diastolic filling pressure elevated; clinically not compromised during mild to moderate workout). Although only 19 patients were retrospectively evaluated, there was a statistically significant (P<0.05) difference in survival among patients who received organs from male (11 vs. 8*) compared with female (8 vs. 2*) (*=death) donors.
In our experience, it is possible to increase the cardiac donor pool by accepting allografts from donors, preferably female, > or =60 years of age in selected cases without a coronary angiogram, if hemodynamic parameters are in a normal range on mild-to-moderate inotropic support. We do not recommend cardiac allografts from donors > or =60 if there are signs of coronary insufficiency in the electrocardiogram, if left ventricle filling pressures are above normal on mild-to-moderate inotropic support and optimum hemodynamic management, or if there are signs of segmental dysfunction or mitral insufficiency >I in the echocardiogram.
心脏移植（HT）已成为终末期心力衰竭患者的一种治疗选择。对心脏同种异体移植物需求的增加已导致向扩大供体标准的转变。在对859例心脏移植受者的回顾性分析中，我们报告了19例接受年龄≥60岁供体心脏同种异体移植的心脏移植患者的血流动力学结果。
从1989年3月至1997年12月，我们在我们的移植中心对74名儿童和809名成人进行了883例原位心脏移植。在此期间，19例患者（17名女性和2名男性）接受了年龄≥60岁供体的心脏同种异体移植。受者年龄范围为57至78岁（平均65±5岁）。
19例患者心脏移植均成功完成。早期死亡率为16%（n = 3）。晚期死亡率为37%（n = 7）。所有长期存活者纽约心脏协会心功能分级均为II级（纽约心脏协会心功能分级II级 = 静息血流动力学：心输出量正常；左心室舒张末期充盈压升高；在轻度至中度运动期间临床无功能受限）。尽管仅对19例患者进行了回顾性评估，但接受男性（存活11例，死亡8例*）与女性（存活8例，死亡2例*）（* = 死亡）供体器官的患者在生存率方面存在统计学显著差异（P < 0.05）。
根据我们的经验，在某些情况下，如果在轻度至中度正性肌力支持下血流动力学参数在正常范围内，在不进行冠状动脉造影的情况下，接受年龄≥60岁供体（最好是女性）的同种异体移植有可能增加心脏供体库。如果心电图有冠状动脉供血不足的迹象、在轻度至中度正性肌力支持和最佳血流动力学管理下左心室充盈压高于正常，或超声心动图有节段性功能障碍或二尖瓣反流>I级的迹象，我们不建议使用年龄≥6岁供体的心脏同种异体移植。
