女性供受体不同性别心脏移植临床观察

Experience in donor-recipient gender mismatching heart transplantation: analysis of seven female patients receiving male donor hearts

目的总结7例供受体性别不同女性受体心脏移植的临床经验。方法7例女性终末期心脏病患者接受同种异体原位心脏移植术,供体为男性,移植早期和远期采用调整性免疫抑制治疗方案。结果7例受者术后长期存活,移植后3个月内均无急性排斥反应、移植物功能不全和严重机会性感染等并发症。2例远期死亡,其余受者生活质量良好。结论供受体性别不同的女性心脏移植受者围术期和远期处理方案应考虑性别因素,才能提高近远期疗效。

Objective To summarize the experience in donor-recipient gender mismatching heart transplantation. Methods Seven female patients with end-stage cardiopathy aged 13~44, underwent orthotopic transplantation of hearts from male donors. Fine-tuning immunosuppressive protocols were adopted: Stanford classic therapy was applied on 3 cases and immunosupression induction therapy was applied on 4 cases. The clinical outcomes were observed for an average of 20 months (5~54 months). Results No acute reject reaction was found in all 7 cases within 3 months postoperatively. The earliest 2 patients died of refractory rejection 38 and 34 months postoperatively due to immunosuppressive withdrawal because of financial difficulty. The other 5 cases resumed their normal work and daily life. No allograft dysfunction, severe opportunistic infection episodes, and injury of liver and kidney functions were found in all cases. Conclusion Fine-tuning immunosuppressive protocols improve the short-term and long-term clinical effects of donor-recipient gender mismatching heart transplantation.