冷缺血时间及供者年龄对心脏移植受者预后的影响:单中心临床研究

Impact of Cold Ischemia Time and Donor Age on the Prognosis of Heart Transplantation: a Single-center Clinical Study

目的:本研究旨在探讨心脏移植中冷缺血时间(cold ischemia time,CIT)及供者年龄对心脏移植受者院内及远期预后的影响。方法:回顾中国医学科学院阜外医院2015~2020年首次行原位心脏移植的518例受者,并根据供心CIT将其分为<4 h组(n=225),4 h≤CIT <6 h组(n=171)及CIT≥6 h组(n=122),每组再根据供者年龄<40岁和≥40岁分为两个亚组。记录受者、供者基本资料与受者术中及术后应用机械辅助的情况,统计院内死亡率以及随访生存率。结果:供者平均年龄(35.5±11.1)岁(5~58岁),平均CIT(4.6±1.7) h(0.9~11.3 h)。CIT <4 h组、4 h≤CIT <6 h组与CIT≥6 h组院内死亡率差异无统计学意义(4.4%vs. 4.7%vs. 6.6%,P=0.70),术中或术后应用机械辅助的受者比例差异也无统计学意义(20.4%vs. 21.6%vs. 30.3%,P=0.93)。亚组分析中,不同CIT组的亚组院内死亡率差异无统计学意义;4 h≤CIT <6 h组中供者≥40岁的受者较供者<40岁的受者术中或术后机械辅助装置应用比例高(27.7%vs. 17.9%,P=0.01),CIT≥6 h组供者≥40岁受者较供者<40岁受者重症监护室(ICU)停留时间长[(9.8±14.3)d vs.(6.4±6.0)d,P=0.01]。随访期间,各CIT组间生存率差异均无统计学意义(P=0.65),各亚组分析中生存率差异均无统计学意义。结论:较长的CIT使接受≥40岁供者供心的受者ICU停留时间显著延长,但对院内死亡率、术中或术后机械辅助的应用比例及随访生存率方面影响不大。

Objectives: To explore the impact of cold ischemia time(CIT) and donor age on in-hospital and long-term outcomes in patients with heart transplantation.Methods: A total of 518 patients, who underwent first orthotopic heart transplantation in Fuwai Hospital from 2015 to 2020, were included. According to the length of CIT, patients were divided into group of <4 hours(n=225) and group of 4 hours≤CIT<6 hours(n=171) and group of ≥6 hours(n=122). Each group was further divided into two subgroups according to the age of donors: group of <40 years and group of >40 years. The basic profiles of recipients and donors were recorded,including applying mechanical assistance during and after operation, postoperative mortality and follow-up survival rate.Results: The average age of donors was(35.5±11.1)(5-58) years and the average CIT was(4.6±1.7)(0.9-11.3) hours.There was no significant difference in hospital mortality and the proportion of patients using mechanical assistance during or after operation among CIT groups(4.4% vs. 4.7% vs. 6.6%, P=0.70;20.4% vs. 21.6 vs. 30.3%, P=0.93). Subgroup analysis showed that there was no significant difference in hospital mortality, but the proportion of applying mechanical assistance was significantly higher in 4 hours ≤CIT<6 hours and higher donor age(≥40 years) subgroup(17.9% vs. 27.7%, P=0.01). ICU length was significantly higher in subgroup with CIT≥6 hours and higher(≥40 years) donor age([6.4±6.0] days vs. [9.8±14.3]days, P=0.01). During follow-up, survival rate was similar among CIT groups and among various subgroups(all P>0.05).Conclusions: Long CIT prolongs ICU stay in patients receiving hearts from elderly donors. However, the proportion of mechanical assistance, in hospital and follow-up mortality are not affected by CIT and donor age.