Utility of long-term surveillance endomyocardial biopsy: A multi-institutional analysis
Utility of long-term surveillance endomyocardial biopsy: A multi-institutional analysis
复制标题
DOI：
10.1016/j.healun.2006.10.003
复制
发表时间：
2006-12-01
影响因子：
8.9
通讯作者：
Kirklin, J. K.
中科院分区：
文献类型：
--
作者：
Stehlik, J.;Starling, R. C.;Kirklin, J. K.
背景：长期肌内膜活检监测在心脏移植受者中的应用受到质疑。本研究旨在通过心脏移植研究数据库的登记，确定晚期排斥反应的危险因素，并研究不同活检监测方案对结果的影响。方法：研究组包括1993年1月1日至2002年1月1日期间在33个中心接受心脏移植的所有成年患者，存活超过移植后第二年，并通过一个明确的监测活检protocol.Results：在一个由24，137患者年，1，626迟发性排斥反应发生的后续行动。移植后较短的时间，排斥反应的历史，年轻的年龄和非洲裔美国人的种族是晚期排斥反应的强有力的危险因素。监测活检的做法因机构而异。持续监测可提高晚期排斥反应的诊断率（RR = 1.3，P = 0.002）。长期与中期监测的患者中，血流动力学损害性排斥反应的发生率没有降低，生存率也没有增加。短期监测与血流动力学损害排斥反应的发生率增加有关，特别是在高危患者中，并增加了非裔美国人patient.Conclusions的死亡率：移植后5年以上的监测活检没有明显的益处。移植后2至5年的监测活检被发现可以降低非裔美国人受体的死亡率。晚期排斥高风险的非非洲裔美国人接受者可能会从移植后5年的监测中受益。
Background: The utility of long-term endomyocardial biopsy surveillance in heart transplant recipients has been questioned. This study was undertaken to identify risk factors for late rejection and to examine the impact of different biopsy surveillance protocols on outcomes using the registry of the Cardiac Transplant Research Database.Methods: The study group consisted of all adult patients who underwent heart transplantation at the 33 centers participating in this investigation between January 1, 1993 and January 1, 2002, survived past the second post-transplant year, and were followed-up by a defined surveillance biopsy protocol.Results: During a follow-up that consisted of 24,137 patient-years, 1,626 late rejections occurred. Shorter time since transplant, history of rejection, younger age and African-American ethnicity of the recipient were strong risk factors for late rejection. The practice of surveillance biopsy varied among institutions. Continued surveillance increased the rate of diagnosis of late rejection (RR = 1.3, P = 0.002). There was no reduction in the incidence of hemodynainically compromising rejection and no increase in survival in patients with long-term vs intermediate-term surveillance. Short-term surveillance was associated with an increased incidence of hemodynamically compromising rejection, particularly among high-risk patients, and increased mortality in African-American patients.Conclusions: There are no apparent benefits from surveillance biopsy beyond 5 years post-transplant. Surveillance biopsy between 2 and 5 years post-transplant was found to reduce mortality in African-American recipients. Non-African-American recipients at high risk for late rejection will likely benefit from surveillance up to 5 years post-transplant.