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评估儿童心脏移植中的捐赠者-接受者尺寸不匹配:从7500多次移植中吸取的教训
Shahnawaz Amdani1, Othman A Aljohani2, James K Kirklin3
1Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
JACC. Heart failure
|September 7, 2023
概括
在儿科心脏移植中,优化捐赠者-接受者尺寸匹配至关重要. 总心脏体积 (TCV) 和身高是预测移植存活率和减少捐赠者丢弃的关键指标.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 儿科手术 儿科手术
背景情况:
- 在儿科心脏移植 (HT) 中,最佳的捐赠者-接受者 (D-R) 尺寸匹配仍然未确定.
- 目前的指标缺乏标准化,影响了移植存活率和患者的结果.
研究的目的:
- 为了确定尺寸不匹配的指标,准确预测儿科心脏移植后的移植存活率.
- 评估各种D-R大小参数对移植存活率和发病率的影响.
主要方法:
- 从儿科心脏移植协会数据库 (1993-2021) 中分析了7,715对D-R对.
- 评估尺寸不匹配 (身高,体重,BMI,BSA,P-H-M,TCV) 对1年和5年的移植存活率和发病率的影响.
- 利用Cox模型与逐步选择来识别移植存活的独立预测因素.
主要成果:
- 总心脏体积 (TCV) 和身高是预测1年和5年的移植存活率的唯一尺寸指标.
- 观察到D-R尺寸不匹配的非线性效应;低于尺寸的高度增加了移植损失和排斥.
- 由于TCV导致的最小供体不足是保护性的,而超过25%的供体不足没有增加移植损失.
结论:
- 总心脏体积 (TCV) 是儿童HT中D-R尺寸匹配的最优度指标.
- 使用TCV和身高标准化D-R尺寸匹配可以提高移植器官的存活率并减少捐赠器官的丢弃.
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