Abstract:

 Objective The purpose of this study is to summarize the situation of non-standard donor hearttransplantations（HTx）in Fuwai Hospital，and to compare the HTx outcomes between non-standard donors group and conventional donors group. Methods A retrospective analysis of HTx cases in Fuwai Hospital from January 2015 to December 2021 was conducted to summarize the use of non-standard donors; compare the clinical data of thetwo groups of recipients; analyze the postoperative survival of the two groups of recipients; explore the association between indicators of non-standard donors and postoperative 1-year mortality. Results A total of 616 HTx patients were analyzed，of which 456 were male（70.0%）and 160 were female（30.0%）. The average age was（46.0 ± 14.1）years. In these patients，330 patients were included in non-standard donor group，and 289 were included in conventional standard

donor group. Compared with the standard donor group，the non-standard donor group have longer cardiopulmonary bypass time，higher proportion of postoperative cardiac dysfunction，postoperative ECMO and IABP insertion and postoperative infection. Longer postoperative mechanical ventilation duration and ICU hospitalization duration，and higher serum creatinine before discharge（P ＜ 0.05）were also seen in the non-standard donor group. In terms of prognosis，the in-hospital mortality of the non-standard donor group was higher. Kaplan-Meier survival analysis showed that the one-year survival rate of the non-standard donor group was lower than that of the standard donor group（P ＜ 0.01），but there was no significant difference in the long-term survival rate of the patients who survived for one year after operation between thetwo groups（P ＝ 0.12）. After adjusting for recipient-related factors，multivariate analysis showed that donor coronaryartery abnormalities and donor high-dose positive inotropic drug support were independent risk factors for one-year mortality. Conclusion The application of non-standard donor heart can alleviate the shortage of donor heart resources，but it may increase post-transplant early mortality. Donor high-dose vasoactive drugs support and abnormal coronary artery of donor heart are risk factors of one-year mortality，so we should pay more attention to the management and assessment of donors before donation.

Key words:

Heart transplantation, Non-standard donor heart, Survival analysis, Risk factor analysis

摘要：

目的 总结阜外医院非标准供体心脏移植情况，对比非标准供体心脏和标准供体心脏移植预后，以探讨使用非标准供体心脏的利弊。方法 回顾性分析 2015 年 1 月至 2021 年 12 月中国医学科学院阜外医院连续心脏移植病例。总结非标准供体心脏的应用情况，比较非标准供体心脏和标准供体心脏移植两组受者的临床资料，分析两组受者术后生存情况，探索各非标准供体心脏评定指标与术后 1 年死亡风险的关系。结果 最终共分析了 616 例心脏移植患者，平均年龄为（46.0 ± 14.1）岁，其中男性受者 456 例（70.0%），女性受者 160 例（30.0%）。330 例接受非标准供体心脏移植，286 例接受了常规标准供体心脏移植。与标准供体心脏组相比，非标准供体心脏组体外循环时间较长，术中超声提示心功能低下的比例较高，术后使用体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）和主动脉内球囊反搏（intra-aortic balloon pump，IABP）辅助的比例较高，术后感染的比例较高，术后机械通气时间较长，术后重症监护病房（intensive care unit，ICU）时间较长，出院前血清肌酐较高（均 P ＜ 0.05）。在预后方面，非标准供体心脏院内病死率更高，Kaplan-Meier 生存分析显示术后 1 年生存率非标准供心组低于标准供心组（P ＜ 0.01），但术后 1 年存活的患者两组远期生存率没有显著差异（P ＝ 0.12）。校正受体相关因素后，多因素分析显示供体心脏冠脉异常、供体大剂量正性肌力药物支持是术后 1 年死亡的独立危险因素。结论 非标准供体心脏的应用可在一定程度上缓解供体心脏资源短缺的现状，但其可能增加心脏移植患者术后早期死亡的风险。供体大剂量血管活性药物支持和供体心脏冠脉异常是移植术后 1 年死亡的危险因素，我们应更加重视供体捐献前管理和供体的评估选择。

关键词:

心脏移植 , 非标准供体心脏 , 预后分析 , 危险因素分析