The effect of timing and graft dysfunction on survival and cardiac allograft vasculopathy in antibody-mediated rejection.
The effect of timing and graft dysfunction on survival and cardiac allograft vasculopathy in antibody-mediated rejection.
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DOI：
10.1016/j.healun.2016.04.007
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发表时间：
2016-09
期刊：
影响因子：
--
通讯作者：
Mancini DM
中科院分区：
文献类型：
--
作者：
Clerkin KJ;Restaino SW;Zorn E;Vasilescu ER;Marboe CC;Mancini DM
抗体介导的排斥反应(AMR)与死亡率增加和心脏移植物血管病变(CAV)有关。早期研究表明，晚期AMR很少与移植物功能障碍有关，而最近的报告表明与死亡率增加有关。我们试图调查AMR的时机及其与移植物功能障碍、死亡率和CAV的关系。这项回顾性队列研究确定了哥伦比亚大学医学中心2004-2013年间的所有成人心脏移植受者(689名患者)。有68例原发AMR病例，按早期(OHT后1年)或晚期(>；1年后)AMR分层。Kaplan-Meier生存分析和建模采用多因素Logistic回归和Cox比例风险回归。从2004年1月1日到2015年10月1日，43名患者有早期AMR(OHT后23天的中位数)，25名患者有晚期AMR(OHT后的中位数1084天)。移植物功能障碍在早期与晚期AMR相比较少见(25.6%比56%，p=0.01)。与早期AMR患者相比，晚期AMR患者AMR后存活率降低(1年80%比93%，5年51%比73%，p<；0.05)。当按移植物功能障碍分层时，只有晚期急性肾移植和移植物功能障碍患者的存活率较差(30天79%，1年%，5年36%，p<；0.006)。这种相关性仍然与年龄、性别、DSA、左冠状动脉内膜成形术的使用、OHT的原因和移植物功能的恢复无关。类似地，晚期移植肾移植和移植物功能障碍的患者加速了新生CAV的发展(1年时50%，HR5.42，p=0.009)，而所有其他组都与普通移植人群相似。晚期AMR常与移植物功能障碍有关。当移植物功能障碍出现在AMR晚期时，早期和持续的死亡风险增加，尽管积极治疗，但仍会迅速发展为新生CAV。
Antibody mediated rejection (AMR) has been associated with increased mortality and cardiac allograft vasculopathy (CAV). Early studies suggested that late AMR was rarely associated with graft dysfunction while recent reports have demonstrated an association with increased mortality. We sought to investigate the timing of AMR and its association with graft dysfunction, mortality, and CAV. This retrospective cohort study identified all adult heart transplant recipients at Columbia University Medical Center from 2004–2013 (689 patients). There were 68 primary cases of AMR, which were stratified by early (<1 year post-OHT) or late (>1-year post-OHT) AMR. Kaplan-Meier survival analysis and modeling was performed with multivariable logistic regression and Cox proportional hazards regression. From January 1, 2004 through October 1, 2015 43 patients had early AMR (median 23 days post-OHT) and 25 had late AMR (median 1084 days post-OHT). Graft dysfunction was less common with early compared with late AMR (25.6% vs. 56%, p=0.01). Patients with late AMR had decreased post-AMR survival compared with early AMR (1-year 80% vs. 93%, 5-year 51% vs. 73%, p<0.05). When stratified by graft dysfunction, only those with late AMR and graft dysfunction had worse survival (30-day 79%, 1-year 64%, and 5-year 36%, p<0.006). The association remained irrespective of age, sex, DSA, LVAD use, reason for OHT, and recovery of graft function. Similarly, those with late AMR and graft dysfunction had accelerated development of de-novo CAV (50% at 1 year, HR 5.42, p=0.009), while all other groups were all similar to the general transplant population. Late AMR is frequently associated with graft dysfunction. When graft dysfunction is present in late AMR there is an early and sustained increased risk of mortality and rapid development of de-novo CAV despite aggressive treatment.
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影响因子：
6.2
作者：
Almuti, Khalid;Haythe, Jennifer;Mancini, Donna
通讯作者：
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Loupy, A.;Toquet, C.;Huyen, J. P. Duong Van
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