Postoperative Outcomes in Infants Undergoing ABO-incompatible Heart Transplantation in the United States.
Postoperative Outcomes in Infants Undergoing ABO-incompatible Heart Transplantation in the United States.
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DOI：
10.1016/j.athoracsur.2021.08.039
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发表时间：
2022-11
期刊：
影响因子：
--
通讯作者：
Mokashi S
中科院分区：
文献类型：
--
作者：
Chauhan D;Orlandi V;Rajab TK;Bedeir K;Volfovsky A;Mokashi S
ABO血型不相容心脏移植是增加婴儿供体库的一种方法。近年来，关于ABO血型不相容心脏移植术后的长期生存和排斥反应的数据仍然有限。对联合器官共享网络（UNOS）数据库中2008年1月至2020年3月进行的婴儿心脏移植进行了查询。收集患者人口统计资料和移植后死亡率的已知危险因素。采用贝叶斯加性回归树（BART）进行统计分析，评估ABO不相容性与总生存、移植物生存、急性排斥发作和住院时间的关系。共纳入1368例（1岁以下）婴儿，其中280例（20.47%）ABO血型不匹配。ABO血型不合与全因死亡率、急性排斥反应或住院时间增加无关。然而，移植时受者的ECMO和插管状态与全因死亡率和移植失败增加有关。特发性心肌病与移植后全因死亡率降低的可能性相关。相容移植与不相容移植的1年、5年和10年生存率分别为90%对88%，82%对79%，77%对73%。ABO血型不相容的婴儿心脏移植不影响移植后的生存、排斥发生率或术后住院时间。因此，增加婴儿供体数量仍然是一个可行和重要的战略。
ABO incompatible heart transplant is a method to increase the infant donor pool. There remains limited data on long term survival and rejection after ABO incompatible heart transplant in recent era. United Network for Organ Sharing (UNOS) database was queried for infant heart transplants performed from January 2008 to March 2020. Patient demographics and known risk factors for post-transplant mortality were collected. Statistical analysis using Bayesian Additive Regression Trees (BART) was performed to evaluate the association of ABO incompatibility and overall survival, graft survival, acute rejection episodes and length of stay. A total of 1,368 infants (age<1 year) were included, of which 280 (20.47%) were ABO incompatible. ABO incompatibility was not associated with increased all-cause mortality, acute rejection episodes or length of stay. Whereas ECMO and intubation status of the recipient at the time of transplantation were associated with increased all-cause mortality and graft failure. Idiopathic cardiomyopathy was associated with a decreased likelihood of post-transplant all-cause mortality. One-, 5- and 10-year survival among compatible vs. incompatible transplants was estimated to be 90% vs. 88%, 82% vs. 79% and 77% vs. 73%, respectively. ABO incompatible infant heart transplant does not affect post-transplant survival, incidence of rejection, or postoperative length of stay. Therefore, it remains a viable and important strategy to increase the infant donor pool.
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