儿童心脏移植22例近远期疗效的单中心回顾性研究

Short-and long-term outcomes of 22 pediatric heart transplantations:A retrospective study in a single center

目的分析儿童心脏移植的近远期疗效。方法回顾性纳入2018年5月—2023年8月于郑州市第七人民医院行心脏移植的受者和供者,分析受者和供者临床特征、手术资料、术后并发症和生存率等。结果22例患儿行心脏移植术,其中男14例、女8例,受者中位年龄13.5(10.0,15.0)岁,中位体重41.9(30.5,55.4)kg。原发病包括:扩张性心肌病16例,肥厚型心肌病1例,心肌致密化不全3例,致右室发育不良心肌病1例,先天性心脏病冠状动脉起源异常1例。供体中位年龄21.0(3.0,29.0)岁,中位体重50.5(47.3,75.0)kg。供受体血型相同,A型10例,B型5例,O型5例,AB型2例。移植前患儿纽约心脏协会心功能分级Ⅳ级,移植前主动脉内球囊反搏(intra-aortic balloon pump,IABP)辅助1例,体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助3例,连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)辅助2例,机械通气2例,9例符合儿童紧急状态分配,患者群体反应性抗体均<10%。供体心脏中位冷缺血时间355.0(262.0,395.5)min,中位升主动脉阻断时间45.0(38.3,51.3)min,中位机械通气时间22.5(16.8,52.5)h,中位术后住院时间为29.5(20.0,43.0)d,中位重症监护室停留时间6.0(5.0,8.3)d。术后行ECMO辅助4例,CRRT辅助2例,7例出现并发症,包括肺部真菌感染6例,肝肾功能不全1例,局部伤口不愈合、纵隔感染1例,多器官功能衰竭1例。Kaplan-Meier曲线分析显示,患儿术后1、3年生存率为91.3%;我中心成人心脏移植术后1、3年生存率分别为86.7%、73.8%,儿童心脏移植生存率高于成人心脏移植生存率。结论心脏移植术治疗儿童终末期心力衰竭效果良好,儿童心脏移植近远期生存率高于成人。儿童心脏移植仍然有很多难点需要解决,需要社会及医疗界的共同努力。

Objective To analyze the short-and long-term therapeutic effects of heart transplantation in children.Methods A retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023,analyzing their clinical characteristics,surgical data,postoperative complications,and survival rates.Results A total of 22 children underwent heart transplantation,including 14 males and 8 females,with a median age of 13.5(10.0,15.0)years and a median weight of 41.9(30.5,55.4)kg.The primary diseases included:dilated cardiomyopathy in 16 patients,hypertrophic cardiomyopathy in 1 patient,myocardial dysplasia in 3 patients,right ventricular dysplasia in 1 patient,and congenital heart disease with abnormal coronary artery origin in 1 patient.The median age of the donors was 21.0(13.0,29.0)years,and the median weight was 50.5(47.3,75.0)kg.The blood types of the donors and recipients were the same,with type A in 10 patients,type B in 5 patients,type O in 5 patients,and type AB in 2 patients.Before transplantation,all children had a New York Heart Association cardiac function gradeⅣ,with 1 patient assisted by intra-aortic balloon pump(IABP),3 patients assisted by extracorporeal membrane oxygenation(ECMO),2 patients assisted by continuous renal replacement therapy(CRRT),and 2 patients on mechanical ventilation.Nine patients met the criteria for emergency child status allocation,and the panel reactive antibody level in the patients was<10%.The median cold ischemic time of the donor heart was 355.0(262.0,395.5)min,the median aortic cross-clamping time was 45.0(38.3,51.3)min,the median mechanical ventilation time was 22.5(16.8,52.5)h,the median postoperative hospital stay was 29.5(20.0,43.0)d,and the median intensive care unit stay was 6.0(5.0,8.3)d.After surgery,4 patients were assisted by ECMO,2 patients by CRRT,and 7 patients developed complications,including lung fungal infection in 6 patients,liver and kidney dysfunction in 1 patient,local wound nonunion and mediastinal infection in 1 patient,and multiple organ failure in 1 patient.Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3%at 1 year and 3 years;the survival rates of adult heart transplant recipients at our center were 86.7%and 73.8%at 1 year and 3 years,respectively,indicating that the survival rate of children with heart transplantation was higher than that of adult patients.Conclusion Heart transplantation is an effective treatment for end-stage heart failure in children,and the short-and long-term survival rates of children with heart transplantation are superior to those of adults.There are still many difficulties to be solved in pediatric heart transplantation,requiring joint efforts from society and the medical community.