在儿科心脏移植患者中,他类药物的不确定的益处:PHTS分析
Madeleine Townsend1, Michael Khoury2, Devin Koehl3
1Cleveland Clinic Children's, Cleveland, Ohio.
概括
在儿科心脏移植接受者早期使用他类药物并没有减少心脏全移植血管病变 (CAV) 或移植失败. 需要进一步的研究,以了解他类药物对儿科和成人心脏移植患者的不同影响.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 儿科健康 儿科健康
背景情况:
- 心脏全移植血管病变 (CAV) 是小儿心脏移植接受者 (HTRs) 移植失败的主要原因.
- 已知他类药物治疗可以降低成人HTRs的CAV和死亡率.
- 对于他类药物在儿科HTR中的作用需要进一步研究.
研究的目的:
- 评估当前儿科HTR中他类药物使用模式.
- 为了确定他类药物使用和CAV发育之间的关联.
- 评估他类药物的使用对儿科HTRs的移植存活率的影响.
主要方法:
- 对儿科心脏移植协会数据库 (2001-2018) 的分析.
- 包括在17岁之前移植的儿科HTR,在没有CAV的情况下在移植后存活≥3年.
- 统计学分析包括Kaplan-Meier,多变量建模和倾向得分匹配.
主要成果:
- 在各中心之间,他类药物的使用有显著的差异,并且在老年儿科接受者 (≥10岁) 中随着时间的推移而增加.
- 多变量分析显示,他类药物使用与移植损失之间没有关联.
- 与没有使用他类药物相比,连续使用他类药物并没有改善移植存活率或减少CAV发病率.
结论:
- 早期,持续的他类药物治疗并没有降低儿科HTR中CAV发生率或移植损失.
- 儿科和成人HTR之间他类药物疗效的差异表明存在不同的潜在风险和介导因素.
- 进一步的研究对于阐明这些差异和优化治疗策略至关重要.
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