Influence of durable mechanical circulatory support and allosensitization on mortality after heart transplantation
Influence of durable mechanical circulatory support and allosensitization on mortality after heart transplantation
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DOI：
10.1016/j.healun.2015.12.023
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发表时间：
2016-06-01
影响因子：
8.9
通讯作者：
Ha, Richard
中科院分区：
文献类型：
--
作者：
Chiu, Peter;Schaffer, Justin M.;Ha, Richard
背景：同种异体敏化已被证明对心脏移植后（HTx）心脏移植有负面影响；即使是负交叉配型也能存活。同种异体致敏是否与机械循环心室辅助装置有关；支持（MCS）是否与htx后更差的生存相关仍存在争议。面板反应性抗体；方法：在联合器官共享网络数据库（2006年7月- 2012年12月机械循环）中列出的成人HTx受者进行鉴定。多因素Cox回归评估同种异体敏化对支持的影响；生存。进行倾向匹配来比较异敏化和非异敏化的患者。Kaplan-Meier生存分析比较了MCS和医学管理队列中匹配和未匹配的患者。结果：我们确定了11840名HTx接受者，其中4167人患有MCS。多因素logistic回归分析显示，MCS与同种异体敏化相关。在多变量Cox回归中，每种不同的MCS装置与htx术后更差的生存相关。异敏化不能预测MCS患者htx后的死亡率（风险比1.07；95%可信区间0.89-1.28;p = 0.48）。在没有MCS的患者中，同种异体敏感化与htx后死亡率相关（风险比为1.19；95%可信区间为1.03-1.39;p = 0.02）。Kaplan-Meier分析显示，异体致敏的MCS患者与非异体致敏的MCS患者相比，未匹配和匹配队列的生存率相当。在非mcs患者中，在非匹配和匹配分析中，同种异体敏化与较差的生存率相关。结论：MCS与异敏化有关。对于MCS患者，同种异体致敏不能独立预测htx后更差的预后。在非mcs患者中，同种异体敏化与htx后更差的生存相关。异敏化似乎是一个受MCS存在影响的异质过程。(C) 2016年国际心肺移植学会。版权所有。
BACKGROUND: Allosensitization has been shown to negatively affect post-heart transplant (HTx) heart transplantation; survival even with a negative crossmatch. Whether allosensitization related to mechanical circulatory ventricular assist devices; support (MCS) is associated with worse post-HTx survival remains controversial. panel reactive antibody;METHODS: Adult HTx recipients listed in the United Network for Organ Sharing database (July 2006-mechanical circulatory December 2012) were identified. Multivariate Cox regression assessed the effect of allosensitization on support; survival. Propensity matching was performed to compare patients who were and were not allosensitized. survival Kaplan-Meier survival analysis compared matched and unmatched patients in the MCS and medically managed cohorts.RESULTS: We identified 11,840 HTx recipients, of whom 4,167 had MCS. MCS was associated with allosensitization in multivariate logistic regression. Each different MCS device was associated with worse post-HTx survival in multivariate Cox regression. Allosensitization did not predict post-HTx mortality in MCS patients (hazard ratio, 1.07; 95% confidence interval, 0.89-1.28; p = 0.48. Among patients without MCS, allosensitization was associated with post-HTx mortality (hazard ratio, 1.19; 95% confidence interval, 1.03-1.39; p = 0.02). Kaplan-Meier analysis revealed equivalent survival in unmatched and matched cohorts when MCS patients who were allosensitized were compared with non-allosensitized MCS patients. Among non-MCS patients, allosensitization was associated with worse survival in unmatched and matched analysis.CONCLUSIONS: MCS was associated with allosensitization. For MCS patients, allosensitization did not independently predict worse post-HTx outcome. Among non-MCS patients, allosensitization was associated with worse post-HTx survival. Allosensitization appears to be a heterogeneous process influenced by presence of MCS. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.