肾移植对缺血性和非缺血性心肌病透析患者左心室射血分数的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-05-11 DOI:10.1111/ctr.70176

Jose Jayme G. De Lima, Luis Henrique W. Gowdak, José Otto Reusing Jr, Elias David-Neto, Luiz A. Bortolotto

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引用次数: 0

摘要

移植中心将左室射血分数（LVEF）降低的患者排除在等候名单之外。目前尚不清楚肾移植是否安全，对缺血性/非缺血性LVEF减少患者的影响不同，以及心肌血运重建术是否会影响预后。方法460例冠脉病变（CAD）患者在RT前后进行LVEF测定，随机分为4组(1组：无CAD， LVEF正常；第二组：冠心病和LVEF正常；第三组：无冠心病，LVEF降低[非缺血性心肌病]；第4组：CAD和LVEF（缺血性心肌病）降低，随访至死亡。结果RT与心肌病患者LVEF升高相关。缺血性心肌病患者生存率降低；冠状动脉介入治疗和药物治疗对结果的影响相当。然而，LVEF或CAD对结果没有影响。结论：在缺血性和非缺血性LVEF减少的患者中，RT可以安全地进行，并且与LVEF的显著改善相关。尽管缺血性疾病患者的长期预后较差，但LVEF和CAD并不是调整后事件或死亡的独立预测因子。因此，即使在冠心病患者中，LVEF降低也不应妨碍RT的指征。

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Effect of Renal Transplantation on Left Ventricular Ejection Fraction in Patients on Dialysis with Ischemic and Nonischemic Cardiomyopathy

Background

Transplant centers exclude patients from the waiting list with reduced left ventricular ejection fraction (LVEF). It is unclear whether renal transplantation (RT) is safe, will have different impacts on patients with ischemic/nonischemic reduced LVEF, and whether myocardial revascularization will influence prognosis.

Methods

Four hundred and sixty RT patients assessed for coronary artery disease (CAD) and with LVEF determined before and after RT were divided into four groups (Group 1: No CAD and normal LVEF [reference]; Group 2: CAD and normal LVEF; Group 3: No CAD and reduced LVEF [nonischemic cardiomyopathy]; Group 4: CAD and reduced LVEF [ischemic cardiomyopathy]) and followed until death.

Results

RT was associated with increased LVEF in patients with cardiomyopathy. Patients with ischemic cardiomyopathy had a reduced survival rate; coronary intervention and medical treatment had comparable effects on outcomes. However, LVEF or CAD did not influence outcomes.

Conclusions

RT can be performed safely in patients with ischemic and nonischemic reduced LVEF and is associated with substantial improvement in LVEF. Although the long-term outcomes were poorer in patients with ischemic disease, LVEF and CAD were not independent predictors of events or death after adjustments. Therefore, reduced LVEF, even in patients with CAD, should not hamper the indication for RT.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.