目的:心脏移植是儿科患者终末期心力衰竭的一种行之有效的治疗方法,表现出优异的长期结果。
方法:这项回顾性研究分析了1986年至2022年在单个机构中244名儿科接受者(<18岁)的35年数据。分析探讨了诊断的变化,生存,等待时间和机械循环支持(MCS)超过三十年(1991-2000年,2001-2010年和2011-2020年)。
结果:在研究期间生存结局显著改善,1年生存率从79.3%(1991-2000)增加到92.3%(2011-2020,P=0.041)。中位总生存期为18.0年,至移植后1年的中位有条件生存期为20.9年.观察到年龄组之间的生存差异,1岁以下婴儿的早期死亡率较高,和青少年(11-17岁)面临增加的长期风险,可能与成人供体特征有关。等待心脏移植的时间增加了,特别是对于较年轻的年龄组(0-5岁和6-10岁),反映了对捐赠器官日益增长的需求。MCS的使用,包括心室辅助装置(VAD),激增,在最近十年中,有67%的接受者接受了移植前VAD支持。重要的是,尽管等待时间延长,VAD使用增加,总体生存率继续良好.
结论:在过去的几十年中,儿科心脏移植后的早期和长期结果一直在不断改善。尽管对供体器官的需求增加,并且越来越依赖VAD作为移植的桥梁,移植后的存活率没有受到影响。
OBJECTIVE: Heart transplantation is a well-established treatment for end-stage heart failure in paediatric patients, demonstrating excellent long-term outcomes.
METHODS: This retrospective study analyses 35 years of data on 244 paediatric recipients (<18 years) at a single institution from 1986 to 2022. The analysis explores changes in diagnoses, survival, waiting times and mechanical circulatory support (MCS) over three decades (1991-2000, 2001-2010 and 2011-2020).
RESULTS: Survival outcomes significantly improved over the study period, with 1-year survival rates increasing from 79.3% (1991-2000) to 92.3% (2011-2020, P = 0.041). The median overall survival was 18.0 years, and median conditional survival to 1 year post-transplant was 20.9 years. Survival differences were noted among age groups, with infants under 1 year of age experiencing higher early mortality, and adolescents (aged 11-17 years) facing increased long-term risks, possibly linked to adult donor characteristics. Waiting times for heart transplantation increased, especially for younger age groups (0-5 and 6-10 years), reflecting the growing demand for donor organs. The use of MCS, including ventricular assist devices (VAD), surged, with 67% of recipients in the most recent decade receiving pre-transplant VAD support. Importantly, despite prolonged waiting times and increased VAD use, overall survival continued to be favourable.
CONCLUSIONS: Early and long-term results after paediatric heart transplantation have been continuously improving over the past decades. Despite an increased demand for donor organs and the growing reliance on VAD as bridge to transplantation, post-transplantation survival is not compromised.