Clinical analysis of 36 patients with allograft orthotopic heart transplantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JING Qiming ^1,2 , WANG Rui ¹ ,  CHEN Xin ^1,2

1. Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R.China;
2. School of Medicine, Southeast University Medical College, Nanjing, 210009, P.R.China;

Corresponding author：

CHEN Xin, Email: stevecx1@163.com

Keywords：

Allograft orthotopic heart transplantation; end-stage heart disease; immunosuppressive therapy

DOI：

10.7507/1007-4848.201903041

Video：

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Objective To analyze the clinical effects of allograft orthotopic heart transplantation.Methods The clinical data of 36 patients with allograft orthotopic heart transplantation performed in the Heart Centre of Nanjing First Hospital from January 1, 2014 to January 1, 2019 were retrospectively analyzed. There were 31 males and 5 females, aged 23-65 (46.2±8.8) years. Protopathy diseases of recipients included dilated cardiomyopathy in 33 patients, end-stage coronary heart disease in 2 patients, and end-stage valvular heart disease in 1 patient. Heart transplantations were performed through double vena cava anastomosis. Immune induction during operations was treated with a combination therapy of both bariximab and methylprednisolone. Postoperatively, all patients were treated with a new triple immunosuppression protocol: FK506+cellcept+prednisone.Results During the perioperative period, 1 patient died of severe infection. For 8 patients with heart failure, after adjustment and intra-aortic balloon pump, the cardiac function of all the 8 patients improved. For 5 patients with renal failure, after continuous renal replacement therapy, the renal function of all the patients returned to normal. One patient died of graft failure after 1 year of follow-up. The follow-up time for each patient postoperatively differed from 3 to 49 months with an average time of 16±4 months while the 1-year survival rate was 97.1% (34/35). Among them, 10 patients were marginal donors, with no significant differences between conventional donors and them. Conclusion For end-stage heart diseases, heart transplantation is one of the effective treatment methods in China with fine early- and middle-term curative effects. Reasonable application of intra-aortic balloon pump, continuous renal replacement therapy and other adjuvant treatments and the new triple immunosuppression protocol can significantly improve the success rate of heart transplantation, reduce the occurrence of acute and chronic rejections. The application of marginal donors can alleviate the current situation of shortage of donors to some extent.

Citation： JING Qiming, WANG Rui, CHEN Xin. Clinical analysis of 36 patients with allograft orthotopic heart transplantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(10): 968-972. doi: 10.7507/1007-4848.201903041 Copy

1.	张世泽, 周思伯, 方立德, 等. 原位心脏移植一例报告. 上海医学, 1978, (10): 1-3.
2.	Tsai FC, Marelli D, Bresson J, et al. Recent trends in early outcome of adult patients after heart transplantation: a single-institution review of 251 transplants using standard donor organs. Am J Transplant, 2002, 2(6): 539-545.
3.	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心血管病杂志, 2018, 46(10): 760-789.
4.	Pizano A, Montes FR, Carreño M, et al. Histidine-tryptophan-ketoglutarate solution versus blood cardioplegia in cardiac surgery: a propensity-score matched analysis. Heart Surg Forum, 2018, 21(3): E158-E164.
5.	潘禹辰, 轩永波, 罗爱国, 等. 供体心肺同时摘取的初步经验. 中国胸心血管外科临床杂志, 2015, 22(8): 792-794.
6.	陈良万, 陈道中, 杨国锋, 等. 61例心脏移植术的供心获取. 中国胸心血管外科临床杂志, 2009, 16(4): 296-299.
7.	简劲峰, 封加涛, 彭峰, 等. 原位心脏移植14例. 中国胸心血管外科临床杂志, 2017, 24(07): 83-86.
8.	文爱东, 蔡振杰, 李彤, 等. 心脏移植受者FK506治疗窗的临床初探. 中华胸心血管外科杂志, 2002, 18(4): 223-225.
9.	Wittwer T, Wahlers T. Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience. Transpl Int, 2008, 21(2): 113-125.
10.	胡盛寿. 中国心脏移植现状. 中华器官移植杂志, 2017, 38(8): 449-454.
11.	石炳毅. 继往开来, 中国器官移植的发展现状--在2018年中华医学会器官移植学年会上的报告. 器官移植, 2019, 10(1): 32-35.
12.	Szczurek W, Szyguła-Jurkiewicz B, Zakliczyński MW, et al. Prognostic value of selected risk scales in patients with end-stage heart failure. Kardiol Pol, 2018, 76(9): 1320-1326.
13.	Bech-Hanssen O, Pergola V, Al-Admawi M, et al. Atrial function in heart transplant recipients operated with the bicaval technique. Scand Cardiovasc J, 2016, 50(1): 42-51.
14.	Kitamura S, Nakatani T, Bando K, et al. Modification of bicaval anastomosis technique for orthotopic heart transplantation. Ann Thorac Surg, 2001, 72(4): 1405-1406.
15.	白杨娟, 王兰兰. 心脏移植术后的免疫抑制治疗和免疫监测. 中国胸心血管外科临床杂志, 2007, 14(1): 51-56.
16.	Zetina-Tun H, Lezama-Urtecho C, Careaga-Reyna G. Routine hormonal therapy in the heart transplant donor. Cir Cir, 2016, 84(3): 230-234.
17.	Grimm M, Rinaldi M, Yonan NA, et al. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients--a large European trial. Am J Transplant, 2006, 6(6): 1387-1397.
18.	Eisen HJ, Kobashigawa J, Keogh A, et al. Three-year results of a randomized, double-blind, controlled trial of mycophenolate mofetil versus azathioprine in cardiac transplant recipients. J Heart Lung Transplant, 2005, 24(5): 517-525.
19.	Furiasse N, Kobashigawa JA. Immunosuppression and adult heart transplantation: emerging therapies and opportunities. Expert Rev Cardiovasc Ther, 2017, 15(1): 59-69.
20.	李乔能, 宁晓暄. 心脏术后发生急性肾损伤的预后危险因素及防治. 心脏杂志, 2017, 29(4): 121-125.
21.	廖中凯, 胡盛寿, 王巍, 等. 床旁持续性肾脏替代治疗在心脏移植术后急性肾功能不全患者中的应用. 中国胸心血管外科临床杂志, 2009, 16(3): 174-178.
22.	Prieto D, Correia PM, Batista M, et al. Primary graft failure after cardiac transplantation: prevalence, prognosis and risk factors. Interact Cardiovasc Thorac Surg, 2018, 27(5): 765-772.
23.	Loforte A, Murana G, Cefarelli M, et al. Role of intra-aortic balloon pump and extracorporeal membrane oxygenation in early graft failure after cardiac transplantation. Artif Organs, 2016, 40(8): E136-E145.
24.	Gadre S, Kotloff RM. Noninfectious pulmonary complications of liver, heart, and kidney transplantation: an update. Clin Chest Med, 2017, 38(4): 741-749.
25.	Toyoda Y, Guy TS, Kashem A. Present status and future perspectives of heart transplantation. Circ J, 2013, 77(5): 1097-1110.
26.	Kamran S, Conti F, Pomey MP, et al. Patients' preferences in transplantation from marginal donors: results of a discrete choice experiment. Transpl Int, 2017, 30(6): 589-602.
27.	Strauer BE, Yousef M, Schannwell CM. The acute and long-term effects of intracoronary Stem cell transplantation in 191 patients with chronic heart failure: the STAR-heart study. Eur J Heart Fail, 2010, 12(7): 721-729.

1. 张世泽, 周思伯, 方立德, 等. 原位心脏移植一例报告. 上海医学, 1978, (10): 1-3.
2. Tsai FC, Marelli D, Bresson J, et al. Recent trends in early outcome of adult patients after heart transplantation: a single-institution review of 251 transplants using standard donor organs. Am J Transplant, 2002, 2(6): 539-545.
3. 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心血管病杂志, 2018, 46(10): 760-789.
4. Pizano A, Montes FR, Carreño M, et al. Histidine-tryptophan-ketoglutarate solution versus blood cardioplegia in cardiac surgery: a propensity-score matched analysis. Heart Surg Forum, 2018, 21(3): E158-E164.
5. 潘禹辰, 轩永波, 罗爱国, 等. 供体心肺同时摘取的初步经验. 中国胸心血管外科临床杂志, 2015, 22(8): 792-794.
6. 陈良万, 陈道中, 杨国锋, 等. 61例心脏移植术的供心获取. 中国胸心血管外科临床杂志, 2009, 16(4): 296-299.
7. 简劲峰, 封加涛, 彭峰, 等. 原位心脏移植14例. 中国胸心血管外科临床杂志, 2017, 24(07): 83-86.
8. 文爱东, 蔡振杰, 李彤, 等. 心脏移植受者FK506治疗窗的临床初探. 中华胸心血管外科杂志, 2002, 18(4): 223-225.
9. Wittwer T, Wahlers T. Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience. Transpl Int, 2008, 21(2): 113-125.
10. 胡盛寿. 中国心脏移植现状. 中华器官移植杂志, 2017, 38(8): 449-454.
11. 石炳毅. 继往开来, 中国器官移植的发展现状--在2018年中华医学会器官移植学年会上的报告. 器官移植, 2019, 10(1): 32-35.
12. Szczurek W, Szyguła-Jurkiewicz B, Zakliczyński MW, et al. Prognostic value of selected risk scales in patients with end-stage heart failure. Kardiol Pol, 2018, 76(9): 1320-1326.
13. Bech-Hanssen O, Pergola V, Al-Admawi M, et al. Atrial function in heart transplant recipients operated with the bicaval technique. Scand Cardiovasc J, 2016, 50(1): 42-51.
14. Kitamura S, Nakatani T, Bando K, et al. Modification of bicaval anastomosis technique for orthotopic heart transplantation. Ann Thorac Surg, 2001, 72(4): 1405-1406.
15. 白杨娟, 王兰兰. 心脏移植术后的免疫抑制治疗和免疫监测. 中国胸心血管外科临床杂志, 2007, 14(1): 51-56.
16. Zetina-Tun H, Lezama-Urtecho C, Careaga-Reyna G. Routine hormonal therapy in the heart transplant donor. Cir Cir, 2016, 84(3): 230-234.
17. Grimm M, Rinaldi M, Yonan NA, et al. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients--a large European trial. Am J Transplant, 2006, 6(6): 1387-1397.
18. Eisen HJ, Kobashigawa J, Keogh A, et al. Three-year results of a randomized, double-blind, controlled trial of mycophenolate mofetil versus azathioprine in cardiac transplant recipients. J Heart Lung Transplant, 2005, 24(5): 517-525.
19. Furiasse N, Kobashigawa JA. Immunosuppression and adult heart transplantation: emerging therapies and opportunities. Expert Rev Cardiovasc Ther, 2017, 15(1): 59-69.
20. 李乔能, 宁晓暄. 心脏术后发生急性肾损伤的预后危险因素及防治. 心脏杂志, 2017, 29(4): 121-125.
21. 廖中凯, 胡盛寿, 王巍, 等. 床旁持续性肾脏替代治疗在心脏移植术后急性肾功能不全患者中的应用. 中国胸心血管外科临床杂志, 2009, 16(3): 174-178.
22. Prieto D, Correia PM, Batista M, et al. Primary graft failure after cardiac transplantation: prevalence, prognosis and risk factors. Interact Cardiovasc Thorac Surg, 2018, 27(5): 765-772.
23. Loforte A, Murana G, Cefarelli M, et al. Role of intra-aortic balloon pump and extracorporeal membrane oxygenation in early graft failure after cardiac transplantation. Artif Organs, 2016, 40(8): E136-E145.
24. Gadre S, Kotloff RM. Noninfectious pulmonary complications of liver, heart, and kidney transplantation: an update. Clin Chest Med, 2017, 38(4): 741-749.
25. Toyoda Y, Guy TS, Kashem A. Present status and future perspectives of heart transplantation. Circ J, 2013, 77(5): 1097-1110.
26. Kamran S, Conti F, Pomey MP, et al. Patients' preferences in transplantation from marginal donors: results of a discrete choice experiment. Transpl Int, 2017, 30(6): 589-602.
27. Strauer BE, Yousef M, Schannwell CM. The acute and long-term effects of intracoronary Stem cell transplantation in 191 patients with chronic heart failure: the STAR-heart study. Eur J Heart Fail, 2010, 12(7): 721-729.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of 36 patients with allograft orthotopic heart transplantation

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