Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratifred by heart failure severity
Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratifred by heart failure severity
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DOI：
10.1136/bmj.321.7260.540
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发表时间：
2000-09-02
影响因子：
--
通讯作者：
Scheld, HH
中科院分区：
文献类型：
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作者：
Deng, MC;De Meester, JMJ;Scheld, HH
目的确定德国心脏移植是否有生存获益。设计前瞻性观察队列研究。1997年德国首次心脏移植的889例成人患者，主要结果指标死亡率，按心力衰竭严重程度分层。（中、低危患者分别为51%、32%和29%; P < 0.0001），在等待名单上死亡的风险最高（32%对20%和20%; P = 0.0003），更有可能接受移植（48%对45%和41%; P = 0.01）。移植后风险组之间的结果差异未达到显著性（P = 0.2）。结论心脏移植在德国目前仅在等待名单上预测死亡高风险的患者中与生存获益相关，预测低或中等风险的患者与移植相关的死亡风险没有降低;应采用挽救器官的方法而不是移植。
Objective To determine whether there is a survival benefit associated with cardiac transplantation in Germany.Design Prospective observational cohort study. Setting All 889 adult patients listed for a first heart transplant in Germany in 1997.Main outcome measure Mortality, stratified by heart failure severity.Results Within 1 year after listing, patients with a predicted high risk had the highest global death rate (51% v 32% and 29% for medium and low risk patients respectively; P < 0.0001), had the highest risk of dying on the waiting list (32% v 20% and 20%; P = 0.0003), and were more likely to receive a transplant (48% v 45% and 41%; P = 0.01). Differences between the risk groups in outcome after transplantation did not reach significance (P = 0.2). Transplantation was not associated with a reduction in mortality risk for the total cohort, but it did provide a survival benefit for the high risk group.Conclusion Cardiac transplantation in Germany is currently associated with a survival benefit only in patients with a predicted high risk of dying on the waiting list Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation.