治疗性血浆置换可提高严重原发性移植物功能障碍的心脏移植受者的存活率。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation Pub Date : 2024-11-17 DOI:10.1016/j.healun.2024.11.014

Yosef Manla MD, David H. Chang MD, Jignesh Patel MD, PhD, Avani Kanungo BS, Andriana Nikolova MD, PhD, Evan Kransdorf MD, PhD, Lawrence S. Czer MD, Lily Stern MD, Michele Hamilton MD, Michelle Kittleson MD, PhD, Jon A. Kobashigawa MD

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引用次数: 0

摘要

背景：原发性移植物功能障碍（PGD）仍是心脏移植术（HTx）后 30 天死亡的主要原因。研究发现，出现严重 PGD 的心脏移植受者体内存在大量与 PGD 发生和心脏移植后存活率有关的循环蛋白。用治疗性血浆置换术（TPE）治疗这些患者是否能减轻持续的免疫和炎症过程并改善移植后的预后，目前尚未得到很好的研究。目的：我们旨在研究TPE治疗对HTx后出现严重PGD的患者30天和1年临床预后的影响：方法：2010 年至 2022 年间，我们纳入了 42 例发生严重 PGD 的 HTx 患者。所有纳入的患者都接受了静脉-动脉体外膜氧合。我们将这些患者分为接受 TPE 和未接受 TPE 的患者（由医生选择）。终点包括30天和1年存活率，以及1年内无任何治疗排斥反应（ATR）、急性细胞排斥反应（ACR）、抗体介导排斥反应（AMR）、活检阴性排斥反应（BNR）、心脏同种异体移植血管病变（CAV）、非致命性主要心脏不良事件（NF-MACE）和HTx后1年内无左心室功能障碍（LVD）：与未接受TPE治疗的患者相比，接受TPE治疗的患者30天（78.1%对40%，P=0.007）和HTx术后1年（56.25%对30%，P=0.035）的存活率均有所提高。然而，在其他相关结果中，包括1年内无CAV、ATR、ACR、AMR、BNR、NF-MACE或LVD，均无统计学意义上的显著差异：结论：TPE 可作为一种很有前景的治疗方法，适用于出现严重 PGD 的 HTx 受体。

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Therapeutic plasma exchange is associated with increased survival in heart transplant recipients experiencing severe primary graft dysfunction

Background

Primary graft dysfunction (PGD) remains the leading cause of 30-day mortality post-heart transplantation (HTx). HTx recipients experiencing severe PGD have been found to have high levels of circulating proteins associated with PGD occurrence and post-HTx survival. Whether treating these patients with therapeutic plasma exchange (TPE) can attenuate ongoing immunological and inflammatory processes and improve post-transplant outcomes has not been well-investigated. Therefore, we aim to examine the impact of treatment with TPE on 30-day and 1-year clinical outcomes of patients experiencing severe PGD post-HTx.

Methods

Between 2010 and 2022, we included 42 HTx patients who developed severe PGD. All included patients were placed on veno-arterial extracorporeal membrane oxygenation. We divided these patients into those who received TPE and those who did not (by physician choice). Endpoints included 30-day and 1-year survival, as well as 1-year-freedom from Any-treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR), biopsy negative rejection (BNR), cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), and freedom from left ventricular dysfunction (LVD) at 1-year post-HTx.

Results

Compared to patients who did not receive TPE, those managed with TPE had increased survival rates at 30 days (78.1% vs. 40%, p = 0.007) and at 1-year post-HTx (56.25% vs. 30% p = 0.035). However, no statistically significant differences were recorded in other outcomes of interest, including 1-year freedom from CAV, ATR, ACR, AMR, BNR, NF-MACE, or LVD.

Conclusion

TPE may serve as a promising therapeutic approach in HTx recipients experiencing severe PGD.

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来源期刊

Journal of Heart and Lung Transplantation 医学-呼吸系统

CiteScore

10.10

自引率

6.70%

发文量

1667

审稿时长

69 days

期刊介绍： The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.