Veleszületett szívhibában szenvedők szív transzplantációjának jelene, jövője Prof. Dr. Bodor Elek

Szívátültetés: HTX

Szívátültetés indokolt minden olyan szívbetegnél, akinek az állapotán már belgyógyászati, (gyógyszeres) vagy sebészi beavatkozással nem lehet javítani és a várható élettartamuk fél - egy év. A transzplantációt csak azoknál szabad indikálni, akiknél a műtétnek ellenjavallata nem áll fenn.

HTX ellenjavallatok Életkor Akut és krónikus fertőzés. (Sepsis) Malignus tumor Jelentős, fixált pulmonalis hypertonia. Súlyos máj és veseelégtelenség. Agyi hypoxia, generalizált érbetegség. Diabetes mellitus Ellenanyag szint alacsony (cross match < 4-6%) Pszihoszociális instabilitás.

Történelem Norman Shumway James Daniel Hardy Christian Barnaard

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has declined in recent years. NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has declined in recent years. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Heart Transplants: January 1, 1991 - June 30, 1995 and January 1, 2001 – June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

HEART TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2005) % of Transplants ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2004) N followed at longest time point: 28,463 Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Therefore, 95% confidence limits are provided about the survival rate estimate; the survival rate shown is the best estimate but the true rate will most likely fall within these limits. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

DIAGNOSIS IN ADULT HEART TRANSPLANTS ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2004) All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital; Coronary Artery Disease vs. ReTx: p < 0.0001; Coronary Artery Disease vs. Valvular: p = 0.01; Valvular vs. ReTx: p < 0.0001; Congenital vs. ReTx: p < 0.0001; ReTx vs. Other: p < 0.0001 Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. The half-life is the estimated time point at which 50% of all of the recipients have died. Survival rates were compared using the log-rank test statistic. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

ADULT HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: 1995 - June 2005) This figure shows the functional status reported on the 1-year, 3-year, 5-year and 7-year annual follow-ups. Because all follow-ups between 1995 and June 2005 were included, the bars do not include the same patients. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) 1988-1995 1/1996-6/2005 % of Cases ISHLT 2006 J Heart Lung Transplant 2006;25:893-903

DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years) 1988-1995 1/1996-6/2005 % of Cases ISHLT 2006 J Heart Lung Transplant 2006;25:893-903

DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years) 1988-1995 1/1996-6/2005 % of Cases ISHLT 2006 J Heart Lung Transplant 2006;25:893-903

Magyarországon eddig 2 HTX congenitalis vitium miatt: 25 éves férfi – Ebstein syndroma 16 éves fiú – Congenitalis aorta stenosis (Ross műtét szövődménye – leszakadt bal coronaria szájadék)

1992. Január 3. Január 19.

Jövő: ? Mustard Senning Nagyartériák veleszületetten korrigált transzpozíciója Bal szívfél hypoplasia (Systemas kamra: jobb kamra)

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