实体器官移植患者接受心脏外科手术的围术期分析

Perioperative outcomes of cardiosurgical patients with a history of solid organ transplantation

目的评估实体器官移植患者接受心脏外科手术的安全性和预后。方法回顾性收集2010年1月至2019年8月期间复旦大学附属中山医院收治的实体器官移植术后接受心脏外科手术患者的临床资料,包括年龄、性别、基础疾病、器官移植种类、器官移植至本次心脏外科手术时间、辅助检查、手术情况、围术期并发症、重症监护病房住院时间、总住院时间,并对存活患者进行随访。结果共纳入14例实体器官移植患者,其中12例(85.7%)为肾移植,1例(7.1%)为肝移植,1例(7.1%)为心脏移植。患者平均年龄(57.5±6.0)岁,移植至本次心脏外科手术平均时间(11.4±5.5)年。平均重症监护病房住院时间(3.6±4.3)天,平均住医院时间(18.4±8.4)天。围术期并发症包括急性肾损伤2例(14.3%),其中1例(7.1%)需要行连续性肾脏替代治;新发心房颤动1例(7.1%);术后感染3例(21.4%),均为肺部感染。30 d内死亡患者2例(14.3%)。存活患者随访3~124个月,平均(38.7±40.3)个月,随访期间无患者死亡,均未出现再住院治疗。结论实体器官移植患者接受心脏外科手术具有良好的短期及长期预后。然而,围术期的感染风险、术后急性肾损伤的发生仍需密切关注。

Objective To evaluate the safety and outcomes of cardiac surgery in solid organ transplant recipients.Methods From January 2010 to August 2019,recipients of solid organ transplantation undergoing cardiac surgery at Zhongshan Hospital,Fudan University were enrolled in this study.Clinical data were retrospectively collected,including age,gender,primary diseases,organ transplantation,time from organ transplantation to cardiac surgery,biochemical data,operative data,perioperative complications,length of stay in ICU(LOS in ICU),length of stay in hospital,and follow-up data of survival patients.Results A total of 14 recipients were enrolled,including 12(85.7%)recipients of kidney transplantation,1(7.1%)liver transplantation,and 1(7.1%)heart transplantation.The average age of the patients was(57.5±6.0)years,and the average time from transplantation to cardiac surgery was(11.4±5.5)years.The mean LOS in ICU was(3.6±4.3)days,and the mean LOS in hospital was(18.4±8.4)days.Acute kidney injury(AKI)occurred in 2(14.3%)patients,one of whom required continuous renal replacement therapy(CRRT).New-onset atrial fibrillation occurred in 1(7.1%)patient.Postoperative infection occurred in 3(21.4%)patients,whose type of infection was lung infection.Two(14.3%)patients died within 30 days.The surviving patients were followed for 3-124 months,with an average of(38.73±40.3)months.During the follow-up period,no patient died and no re-hospitalization occurred.Conclusion Solid organ transplant recipients receiving cardiac surgery have good short-term and long-term outcomes.However,complications of infection and AKI during the perioperative period are common.