Effect of Supportive Treatment and Donor Characteristics on Outcomes after Heart Transplantation

Autor: Shiou-Lan Wu, 吳秀蘭
Rok vydání: 2010
Druh dokumentu: 學位論文 ; thesis
Popis: 98
Background: The prevalence of heart failure in Taiwan is getting higher nowadays. Heart transplantation is currently the most definitive way for treating patients with end-stage cardiomyopathies. However, whether the patients received preoperative treatment of different types of the mechanical circulatory supports (MCS) and donor characteristics affect patients' postoperative quality of care. But we haven’t known whether mechanical circulatory supports and donor characteristics may influence the survival of heart transplantation patients in Taiwan. The purpose is to evaluate the effect of MCS and donor characteristics on the patients’ quality of care after heart transplantation. Methods: The retrospective cohort study analyzed the results of 329 patients who underwent the first heart transplantation and donor can be paired for the study between January 2003 and December 2008. These data were further linked with records in claim files and provider files of National Health Insurance (NHI) database. The Cox proportional hazard model was used to analyze the relation between using MCS and donor characteristics and the survival of heart transplantation patients. Results：Recipients with ECMO have increased year by year, and in2008 all recipients used ECMO; combined with MCS also increased. The use of inotropic drug for donors was increasing after 2005. Postoperative mortality rate within 30 days was 8.51%, and 1, 3 and 5-year survival rates were 77.23%, 64.27%, 57.03%. The descending trend of more than one-year survival curves after heart transplantation was larger compared with the International Society of Heart and Lung Transplantation study (3.4% / year). The within 30 days death can be reduced 93% (OR = 0.07,95% CI = 0.27-1.40) for ECMO + VAD patients compared with only use of ECMO, and 41% (HR = 0.59,95% CI = 0.25-1.40 ) after risk adjustment. This revealed that ECMO + VAD after heart transplantation would help to reduce the risk of death. The increasing ventilator days significantly related to higher risk of death. However, the impacts of donors and recipients match of ageor sexon the survival were not significant.The cause of death for donor in cerebrovascular disease had significantly higher risk of death in recipients (HR = 2.44,95% CI = 1.13-5.30). Recommendation: Health policy-makers should strengthen the assessment of the long-term survival situations for patients with circulation aids and of cost-benefit analysis with only using one, or two or more aids circulation.Medical providers should strengthen the survival assessment within 3 years after heart transplantation, basing on the results to improve, and combined with clinical data to assess the use of inotropic drugs and ECMO + VAD + IABP effectiveness. Furthermore, we suggest exploring the impact of using the anti-rejection drugs on the re-admission and survival.
Databáze: Networked Digital Library of Theses & Dissertations
Externí odkaz: