Circulation:左心室辅助装置显著增加心脏移植后的早期死亡率

2019-08-14 MedSci MedSci原创

左心室辅助装置(LVADs)是等待心脏移植的心力衰竭(HT)患者的桥接移植(BTT)。HT列表的标准在医疗管理的患者和机械连接到HT的患者之间没有区别。现研究人员对以LVADs作为BTT对心脏移植预后的影响进行研究。研究人员从美国器官共享数据库中筛选出5486位2008年-2015年期间进行单器官移植的HT个体。机械桥接患者的早期死亡率较高:第一年死亡率为 9.5% vs 7.2%(p<0.

左心室辅助装置(LVADs)是等待心脏移植的心力衰竭(HT)患者的桥接移植(BTT)。HT列表的标准在医疗管理的患者和机械连接到HT的患者之间没有区别。现研究人员对以LVADs作为BTT对心脏移植预后的影响进行研究。

研究人员从美国器官共享数据库中筛选出5486位2008年-2015年期间进行单器官移植的HT个体。

机械桥接患者的早期死亡率较高:第一年死亡率为 9.5% vs 7.2%(p<0.001)。肾小球滤过率在40-60mL/min·1.73m2和<40 mL/min·1.73m2的BTT患者的1年死亡风险增高(优势比OR分别是1.69和2.16)。在体重指数为25-30kg/m2和>30kg/m2的患者中观察到相似的趋势(OR 分别是1.88和2.11)。如果将患者按BTT状态和已知的风险因素(包括年龄>60岁、肾小球滤过率<40 mL/min·1.73m2和体重指数>30kg/m2)分层,中、高危药物桥接患者和机械桥接患者的1年死亡率则存在显著差异,BTT高危患者1年死亡率为17.6%,而接受药物桥接治疗的高危患者1年死亡率为10.4%。

LVAD作为HT的过渡治疗,虽然能够提高等待HT患者的存活率,但会显著增加移植后的早期死亡风险。可能需要更仔细地考虑LVAD植入后的移植资格。

原始出处:

Lauren K. Truby , et al.Impact of Bridge to Transplantation With Continuous-Flow Left Ventricular Assist Devices on Posttransplantation Mortality. Circulation. 2019;140:459–469. https://doi.org/10.1161/CIRCULATIONAHA.118.036932

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