Donor age is a predictor of early low output after heart transplantation.
Donor age is a predictor of early low output after heart transplantation.
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DOI：
10.1016/j.jjcc.2015.07.007
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发表时间：
2016-05
影响因子：
2.5
通讯作者：
T. Fujino;K. Kinugawa;D. Nitta;T. Imamura;H. Maki;E. Amiya;M. Hatano;M. Kimura;O. Kinoshita;K. Nawata;I. Komuro;M. Ono
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文献类型：
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作者：
T. Fujino;K. Kinugawa;D. Nitta;T. Imamura;H. Maki;E. Amiya;M. Hatano;M. Kimura;O. Kinoshita;K. Nawata;I. Komuro;M. Ono
背景使用来自边缘供体的心脏可能与原发性移植物功能障碍的风险增加和长期存活率低有关。然而，与心脏移植（HTx）后延迟心肌恢复相关的因素仍然未知。我们试图澄清的风险因素，预测早期低输出HTx后，并调查是否早期低输出影响中期graft dysfunctions.MethodsWe回顾性分析了在东京大学医院接受HTx的患者。早期低心排患者是指HTx后1周使用静脉正性肌力药物后，心脏指数（CI）仍<2.2L/min/m2的患者。结果我们纳入了45例连续HTx受者，其中11例患者为早期低心排组，其余患者为早期保留心排组。我们进行了单变量logistic分析，发现供体年龄是预测早期低输出的唯一显著因素（优势比1.107，95%置信区间1.034- 1.210，p = 0.002）。早期低输出量组患者的CI逐渐升高，并在HTx后2周赶上早期保留输出量组患者（早期低输出量组2.4 ± 0.6 L/min/m2 vs早期保留输出量组2.5 ± 0.5 L/min/m2，p= 0.684）。早期低心排患者血浆B型利钠肽浓度较高（1118.5 ± 1250.2 pg/ml vs 526.4 ± 399.5 pg/ml; p= 0.033），1周时为703.6 ± 518.4 pg/ml vs 464.6 ± 509.0 pg/ml（p= 0.033），第2周为387.7 ± 231.9 pg/ml vs 249.4 ± 209.5 pg/ml（p= 0.010）HTx后4周，结论供体年龄是HTx术后早期低排血量的预测因素。我们得小心从老捐献者那里得到的血液。但早期低心排患者的血流动力学指标逐渐赶上早期保留心排患者。
BackgroundUsing hearts from marginal donors could be related to increased risk of primary graft dysfunction and poor long-term survival. However, factors associated with delayed myocardial recovery after heart transplantation (HTx) remain unknown. We sought to clarify risk factors that predict early low output after HTx, and investigated whether early low output affects mid-term graft dysfunction.MethodsWe retrospectively analyzed patients who had undergone HTx at The University of Tokyo Hospital. We defined early low output patients as those whose cardiac index (CI) was <2.2 L/min/m2despite the use of intravenous inotrope at 1 week after HTx.ResultsWe included 45 consecutive HTx recipients, and classified 11 patients into early low output group, and the others into early preserved output group. We performed univariable logistic analysis and found that donor age was the only significant factor that predicted early low output (odds ratio 1.107, 95% confidence interval 1.034–1.210,p= 0.002). CI of early low output patients gradually increased and it caught up with that of early preserved output patients at 2 weeks after HTx (2.4 ± 0.6 L/min/m2in early low output group vs 2.5 ± 0.5 L/min/m2in early preserved output group,p= 0.684). Plasma B-type natriuretic peptide concentration of early low output patients was higher (1118.5 ± 1250.2 pg/ml vs 526.4 ± 399.5 pg/ml;p= 0.033) at 1 week, 703.6 ± 518.4 pg/ml vs 464.6 ± 509.0 pg/ml (p= 0.033) at 2 weeks, and 387.7 ± 231.9 pg/ml vs 249.4 ± 209.5 pg/ml (p= 0.010) at 4 weeks after HTx, and it came down to that of early preserved output patients at 12 weeks after HTx.ConclusionsDonor age was a predictor of early low output after HTx. We should be careful after HTx from old donors. However, hemodynamic parameters of early low output patients gradually caught up with those of early preserved output patients.