心脏移植的发展现状和新挑战

Development status and new challenges of heart transplantation

心脏移植是终末期心力衰竭患者的首选治疗。供者不足一直以来都是限制心脏移植数量增长的主要问题,随着新技术的不断更新和引入,供者池被不断扩大,比如使用年龄较大的供者、丙型肝炎病毒感染的供者、毒品过量致死的供者或心脏死亡器官捐献(DCD)供者的心脏等。与此同时,高龄、多器官功能不全、机械循环支持及人类白细胞抗原抗体致敏受者的比例近几年明显增加。供者数量的不足、受者状况的复杂化、免疫抑制治疗的个体化管理和远期移植物血管病的防治等都是心脏移植领域面临的挑战。本文通过概述现今全球在扩大供者库、提高受者质量、加强排斥反应的诊治和心脏移植物血管病变的预防等方面的新进展,以期有助于改善在等待或已经接受心脏移植的终末期心力衰竭患者的生存时间和生活质量。

Heart transplantation is the primary therapeutic option for patients with end-stage heart failure.The shortage of donors has been the main limiting factor for the increasing quantity of heart transplantation.With persistent updating and introduction of novel technologies,the donor pool has been increasingly expanded,such as using the heart from older donors,donors infected with hepatitis C virus,donors dying from drug overdose or donation after cardiac death(DCD)donors,etc.Meantime,the proportion of recipients with advanced age,multiple organ dysfunction,mechanical circulatory support and human leukocyte antigen antibody sensitization has been significantly increased in recent years.The shortage of donors,complication of recipients’conditions,individualized management of immunosuppressive therapy and prevention and treatment of long-term cardiac allograft vasculopathy are all challenges in the field of heart transplantation.In this article,novel progresses on donor pool expansion,improving the quality of recipients,strengthening the diagnosis and treatment of rejection,and preventing cardiac allograft vasculopathy were reviewed,aiming to prolong the survival and enhance the quality of life of patients with end-stage heart failure on the waiting list or underwent heart transplantation.