Cardiac Transplantation Current Outcomes and Contemporary Controversies
Cardiac Transplantation Current Outcomes and Contemporary Controversies
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DOI：
10.1016/j.jchf.2017.08.021
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发表时间：
2017-12-01
影响因子：
13
通讯作者：
Kobashigawa, Jon A.
中科院分区：
文献类型：
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作者：
Kittleson, Michelle M.;Kobashigawa, Jon A.
尽管慢性心力衰竭的药物和器械治疗取得了进展，但长期发病率和死亡率仍然很高，许多患者进展为终末期心力衰竭。在过去的50年里，心脏移植（HTx）已成为终末期心脏病患者的首选治疗方法。然而，尽管HTx已成为终末期心力衰竭管理的标准治疗，但挑战仍然存在。终末期心力衰竭患者的数量正在增加，而供体器官的数量保持不变，这是HTx的限制因素。不仅有更多潜在的心脏移植候选人，而且今天的HTx候选人更加复杂：年龄较大，致敏，需要机械循环支持。这样的候选人有更高的风险，包括原发性移植功能障碍和抗体介导的排斥反应不良的结果。本文重点介绍目前移植后的结果和HTx的最新进展，可以解决当前的挑战。这些进展包括：1）试图扩大供体库; 2）建议改变HTx分配政策，以实现更公平的器官分配; 3）更好地理解原发性移植物功能障碍的定义和管理; 4）在致敏HTx候选人的管理方面取得进展。这些领域的发展可能会扩大和更公平地分配捐赠者库，并改善HTx接受者的生存和生活质量。(C)2017年由美国心脏病学会基金会。
Despite advances in pharmacologic and device treatment of chronic heart failure, long-term morbidity and mortality remain high, and many patients progress to end-stage heart failure. Over the last 5 decades, heart transplantation (HTx) has become the preferred therapy for select patients with end-stage heart disease. However, although HTx has become standard of care for the management of end-stage heart failure, challenges continue to exist. The number of patients with end-stage heart failure is increasing, whereas the number of donor organs remains constant and a limiting factor in HTx. Not only are there more potential heart transplantation candidates, but HTx candidates today are more complex: older, sensitized, and in need of mechanical circulatory support. Such candidates are at higher risk for poor outcomes including primary graft dysfunction and antibody-mediated rejection. This article focuses on current post-transplantation outcomes and recent advances in HTx that could address the current challenges. These advances include: 1) attempts to expand the donor pool; 2) proposed changes in HTx allocation policy for more equitable organ distribution; 3) a better understanding of the definition and management of primary graft dysfunction; and 4) advances in the management of sensitized HTx candidates. Developments in these areas could result in expansion and more equitable distribution of the donor pool and improved survival and quality of life for HTx recipients. (C) 2017 by the American College of Cardiology Foundation.