扩大标准供者供心的选择策略与临床结果

目的 研究心脏移植扩大标准供者供心的选择策略并分析其移植后的临床效果.方法 共有146例晚期心脏病患者接受心脏移植术.将供心总缺血时间超过6 h,供者年龄在40岁以上,供、受者血型不匹配,供、受者体重不匹配作为扩大标准供者供心.分析和比较扩大标准供者供心与正常供心移植后受者的临床效果.结果 术后受者共死亡11例,总体死亡率为7.5%,经移植心肌活组织检查证实发生急性排斥反应14例,发生率为9.6%.年龄大于40岁的供者有10例,供心缺血时间在6 h以上者有21例.供、受者血型不匹配者有3例.扩大标准供者供心与正常供心移植后受者的死亡率、使用呼吸机时间、住院时间、受者心功能(包括左心、右心功能)、重度排斥反应发生率及并发症等方面的比较,差异无统计学意义(P>0.05).3例血型不匹配者术后已分别存活1年8个月、9个月和1个月,均未发生明显排斥反应.结论 扩大标准供者供心可缓解供心短缺问题,且并未影响移植术后受者近期及中期的临床效果.

Strategy of expanding marginal donor heart and elinical result

Objective To study the strategy of expanding standard donor heart application and to analyze the clinical effect on applying expanding standard donor heart in heart transplantation.Methods 146 patients received heart transplantation in Fuwai Hospital Bering from June 2004 to February 2009.Expanding standard donor heart was defined as prolonged ischemic time over 6 h,advanced age up to 40,and blood type ABO mismathched.Blood type examination and PRA test were done before operation.The donor heart was preserved by sequential perfusion with cold St.Thomas and HTK solution.The patients were divided into groups according to different oversize body weight,ischemic time,and donor age Results There were 11 deaths after operation.Ischernic time of donor heart was 262.1±120.8 min,and that of 21 donors was over 360 min(the longest one was 605 min).There was no significant diffeFence in recipient properties before transplantation.and also there was no significant difference in mortality,heart function,heart rejection,and main morbidity after transplantation and during follow-up.Conclusion These data support continued aggressive utilization of expanding standard donor hearts in heart transplantation.Our experience demonstrates thatproperly expanding standard cardiac allografts application has no effects on the short- and long-term clinical outcome following heart transplantation.