一方面由于晚期心力衰竭的患病率越来越高,另一方面由于器官短缺,基于对潜在危险因素的了解,不仅在早期,而且在心脏移植后的长期过程中也是非常重要的。因此,本研究的目的是在该患者群体中确定晚期死亡的诱发因素.
回顾性分析在当前中心随访期间收集的长期心脏移植患者的数据。临床,实验室,包括免疫监测和幻影检查结果在内的全因死亡率研究.
102例心脏移植后患者(平均:13.2±6.4年)分为两组:幸存者(n=133)和非幸存者(n=39)。与幸存者相比,非幸存者的特点是肾功能不全明显更明显,透析频率更高,贫血和更差的功能状态。此外,非幸存者从相对更肥胖的供体获得心脏.在多变量Cox回归分析中,以下参数被证明是死亡率增加的独立危险因素:CD4百分比<42%,C反应蛋白≥0.5mg/dL,过去存在需要治疗的拒绝,心脏移植后<5年发生同种异体心脏血管病变,不使用β受体阻滞剂。
低CD4+细胞百分比,持续的炎症,相关机关拒绝,早期发生移植血管病变和未使用β受体阻滞剂是心脏移植后长期随访中死亡率较高的危险因素.
Because of the growing prevalence of terminal heart failure on the one hand and organ shortage on the other hand, an optimal care of heart transplant recipients based on the knowledge of potential risk factors not only early, but also in a long-term course after heart transplantation is of great importance. Therefore, the aim of the present study was to identify predisposing factors for late mortality in this patient collective.
Data from long-term heart transplant patients collected during follow-up visits in the current center were retrospectively analyzed. Clinical, laboratory, including immune monitoring and apparative examination results were studied with regard to all-cause mortality.
One hundred and seventy-two patients after heart transplantation (mean: 13.2 ± 6.4 years) were divided into two groups: survivors (n = 133) and non-survivors (n = 39). In comparison with survivors, non-survivors were characterized by significantly more pronounced renal insufficiency with more frequent dialysis, anemia and worse functional status. Additionally, non-survivors obtained hearts from relevantly more obese donors. In a multivariate Cox regression analysis the following parameters were shown to be independent risk factors for increased mortality: CD4 percentage < 42%, C-reactive protein ≥ 0.5 mg/dL, presence of rejections requiring therapies in the past, onset of cardiac allograft vasculopathy < 5 years following heart transplantation and no use of beta-blockers.
Low CD4+ cell percentages, sustained inflammation, relevant organ rejections, early onset of transplant vasculopathy and no use of beta-blockers are risk factors for higher mortality in a long-term follow-up after heart transplantation.