The changing pattern of humoral rejection in cardiac transplant recipients
The changing pattern of humoral rejection in cardiac transplant recipients
复制标题
DOI：
10.1097/01.tp.0000278094.41131.9f
复制
发表时间：
2007-08-27
期刊：
影响因子：
6.2
通讯作者：
Mancini, Donna
中科院分区：
文献类型：
--
作者：
Almuti, Khalid;Haythe, Jennifer;Mancini, Donna
背景大多数体液性排斥反应（HR）发生在心脏移植后早期，与血流动力学受损和预后不良有关。晚期HR病例（移植后> 6个月）已有报道。我们研究了移植早期（< 6个月）和晚期HR患者的临床特征和结局的差异。我们对1995年1月1日至2006年3月1日在一家大型移植中心发生的所有HR病例进行了回顾性病历分析。共有37例成人移植患者经活检证实HR; 13例患者有早期HR，24例患者在移植后平均5年（范围，7个月至17年）有HR。HR治疗包括血浆置换、环磷酰胺和利妥昔单抗。早期和晚期体液排斥反应者的年龄相似（58 +/- 14 vs. 50 +/- 14岁; P=0.12）。在早期HR组中有更多女性的趋势（54%对33%）。左心室辅助装置的使用相似（38% vs. 33%）。早期拒绝者更可能有阳性交叉配型（46% vs.8%; P < 0.01）。晚期HR患者同时诊断为恶性肿瘤或近期感染，50%与8%的早期HR患者合并，表明非人类白细胞抗原抗体介导的急性疾病免疫应答激活。两组诊断为HR后的1年生存率均为78%（P=NS）。体液性排斥反应现在更频繁地发生在远端移植的患者中，并且通常与恶性肿瘤或感染的存在相关。
Background. Most humoral rejection (HR) episodes occur early after cardiac transplantation and are associated with hemodynamic compromise and poor prognosis. Late cases of HR (> 6 months after transplant) have been reported. We examined the differences in clinical characteristics and outcomes in patients presenting with HR in the early (< 6 months) and late transplant periods.Methods. A retrospective chart review was performed of all cases of HR at a single large transplant center from January 1, 1995 to March 1, 2006.Results. A total of 37 adult transplants had biopsy-proven HR; 13 patients had early HR and 24 patients had HR a mean of 5 yr after transplantation (range, 7 months to 17 yrs). Treatment for HR included plasmapheresis, cyclophosphamide, and rituximab. The age of the early and late humoral rejecters was similar (58 +/- 14 vs. 50 +/- 14 yrs; P=0.12). There was a trend toward more women in the early HR group (54% vs. 33%). Use of left ventricular assist devices was similar (38% vs. 33%). Early rejecters were more likely to have positive cross-matches (46% vs. 8%; P < 0.01). Patients with late HR had a coexistent diagnosis of malignancy, or significant recent infection in 50% vs. 8% for early HR, suggesting an activation of a nonhuman leukocyte antigen antibody-mediated immune response to an acute illness. One-year survival after the diagnosis of HR was 78% for the both groups (P=NS).Conclusions. Humoral rejection occurs now more frequently in patients with remote transplants and is commonly associated with the presence of malignancy or infection.