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Titolo:
The role of donor age and ischemic time on survival following orthotopic heart transplantation
Autore:
Del Rizzo, DF; Menkis, AH; Pflugfelder, PW; Novick, RJ; McKenzie, FN; Boyd, WD; Kostuk, WJ;
Indirizzi:
UnivN6Astern Ontario, London Hlth Sci Ctr, Div Cardiovasc Surg, London, ONUniv Western Ontario London ON Canada N6A 5A5 Cardiovasc Surg, London, ON
Titolo Testata:
JOURNAL OF HEART AND LUNG TRANSPLANTATION
fascicolo: 4, volume: 18, anno: 1999,
pagine: 310 - 319
SICI:
1053-2498(199904)18:4<310:TRODAA>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
CARDIAC-FUNCTION; RECIPIENT; POOL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
11
Recensione:
Indirizzi per estratti:
Indirizzo: Del Rizzo, DF Univ,339tern Ontario, London Hlth Sci Ctr, Div Cardiovasc Surg, Univ Campus Univ Western Ontario Univ Campus,339 Windermere Rd,POB 5339,Suite 6-L2 London ON Canada N6A 5A5
Citazione:
D.F. Del Rizzo et al., "The role of donor age and ischemic time on survival following orthotopic heart transplantation", J HEART LUN, 18(4), 1999, pp. 310-319

Abstract

Background: The advances in immunotherapy, along with a liberalization of eligibility criteria have contributed significantly to the ever increasing demand for donor organs. In an attempt to expand the donor pool, transplantprograms are now accepting older donors as well as donors from more remoteareas. The purpose of this study is to determine the effect of donor age and organ ischemic time on survival following orthotopic heart transplantation (OHT). Methods: From April 1981 to December 1996 372 audit patients underwent OHTat the University of Western Ontario. Cox proportional hazards models wereused to identify predictors of outcome. Variables affecting survival were then entered into a stepwise logistic regression model to develop probability models for 30-day- and 1-year-mortality. Results: The mean age of the recipient population was 45.6 +/- 12.3 years (range 18-64 years: 54 less than or equal to 30; 237 were 31-55; 91 > 56 years). The majority (329 patients, 86.1%) were male and the most common indications for OH were ischemic (n = 180;) and idiopathic (n = 171) cardiomyopathy. Total ischemic time (TIT) was 202.4 +/- 84.5 minutes (range 47-457 minutes). In 86 donors TIT was under 2 hours while it was between 2 and 4 hours in 168, and more than 4 hours in 128 donors. Actuarial survival was 80%,73%, and 55% at 1, 5, and 10 years respectively. By Cox proportional hazards models, recipient status (Status I-II vs III-TV; risk ratio 1.75; p = 0.003) and donor age, examined as either a continuous or categorical variable([age < 35 vs greater than or equal to 35; risk ratio 1.98; p < 0.001], [age < 50 vs greater than or equal to 50; risk ratio 2.20; p < 0.001], [age <35 vs 35-49 versus greater than or equal to 50; risk ratio 1.83; p < 0.001]), were the only predictors of operative mortality. In this analysis, total graft ischemic time had no effect on survival. However, using the Kaplan-Meier method followed by Mantel-Cox logrank analysis, ischemic time did have a significant effect on survival if donor age was >50 years (p = 0.009). By stepwise logistic regression analysis, a probability model for survival was then developed based on donor age, the interaction between donor age and ischemic time, and patient status. Conclusions: Improvements in myocardial preservation and peri-operative management may allow for the safe utilization of donor organs with prolonged ischemic times. Older donors are associated with decreased peri-operative and long-term survival following OHT, particularly if graft ischemic time exceeds 240 minutes and if these donor hearts are transplanted into urgent (Status III-IV) recipients.

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Documento generato il 22/09/20 alle ore 20:47:02