考虑与45岁或以上的捐赠者进行心脏移植时的风险因素:使用UNOS数据开发一种新的死亡风险评分
Anh Nguyen1, Abbas Rana2, Alexis Shafii1
1Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, Texas.
JHLT open
|February 20, 2026
概括
较老的捐赠者心脏 (≥45岁) 可以用于心脏移植,但仔细查捐赠者和接受者的特定风险因素对于更好的患者生存结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 公共卫生 公共卫生
背景情况:
- 目前的指导方针允许45岁以上的供体心脏,如果冠状动脉疾病不存在,缺血时间小于4小时.
- 这项研究调查了老年捐赠心脏患者生存的额外危险因素.
研究的目的:
- 确定影响心脏移植患者生存的风险因素,使用年龄≥45.5岁的捐赠者.
- 为接受老年捐赠心脏的人制定风险评分.
主要方法:
- 成年人心脏移植的回顾性队列研究,使用年龄≥45的捐赠者 (2000-2024年).
- 利用了美国器官共享网络的数据.
- 多变量考克斯回归确定了死亡风险因素.
主要成果:
- 在58,859例移植中,9,843例 (16.7%) 使用了45岁以上的捐赠者.
- 一年,5年和10年的生存率分别为87.0%,73.3%和53.5%.
- 显著的危险因素包括:缺血时间≥4小时,CMV阳性捐赠者,捐赠者吸烟,接受者年龄>55,黑人种族,肥胖,糖尿病,移植前透析/通风和之前的心脏手术.
结论:
- 查特定的捐赠者和接受者因素对于优化老年捐赠者心脏的结果至关重要.
- 确定的危险因素包括缺血时间,CMV状态,捐赠者的吸烟,以及接受者的特征,如年龄,种族,肥胖,糖尿病和移植前条件.
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