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边缘心脏全移植在替代列表移植中没有增加主移植功能障碍
Brian Lima1, Keshava Rajagopal, Rebecca P Petersen
1DUMC Box 3043, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Circulation
|July 6, 2006
概括
主要移植功能障碍 (PGD) 的发生率在替代列表 (AL) 和标准列表 (SL) 心脏移植 (HT) 之间是相似的. 移植前心室辅助装置 (VAD) 和延长的缺血时间预测PGD,支持使用边缘供体心脏.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 免疫学 免疫学 免疫学
背景情况:
- 临床心脏移植 (HT) 的成功促使开发了替代列表 (AL) 的HT策略.
- 对于那些不符合标准的HT标准的接受者,AL HT使用边缘心脏全移植.
- 边缘异位移植可能会增加原发性移植功能障碍 (PGD) 的风险,这是早期HT后死亡的主要原因.
研究的目的:
- 为了确定与标准清单 (SL) HT相比,AL HT中的PGD发病率.
- 在心脏移植接受者中确定PGD的预测因子.
主要方法:
- 从2000年至2005年间对260名接受SL HT (n=207) 或AL HT (n=53) 的成年患者进行了回顾性分析.
- 根据需要机械循环支持或HT后高剂量异型药物的需求定义的PGD.
- 由于冠状动脉疾病或心室功能障碍等因素,AL供体心脏因SLHT而被拒绝.
主要成果:
- 在ALHT和SLHT接受者之间,PGD的发病率没有显著差异.
- 接受ALHT的患者年龄较大,患糖尿病和缺血性心肌病率较高.
- 移植前心室辅助装置 (VAD) 和延长的总缺血时间 (≥4.5小时) 是PGD的独立预测因素.
结论:
- 在AL HT中,边缘供体心脏没有显示出PGD发病率的增加.
- 移植前的VAD和延长的缺血时间是PGD的关键决定因素.
- 这些发现支持在AL HT中继续使用边缘供体心脏.
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