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移植への橋渡しとして,連続流動の左心房アシスト装置が移植後の死亡率に与える影響
Lauren K Truby1, Maryjane A Farr2, A Reshad Garan2
1Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (L.K.T.).
Circulation
|June 18, 2019
まとめ
左心室補助装置 (LVAD) を用いて心臓移植 (HT) を受けた患者は,より高い早期死亡リスクに直面します. 移植の適格性を慎重に検討することは,これらの機械的に支援された患者にとって極めて重要です.
科学分野:
- 心臓病科
- 移植医学
- メカニカル・サーキュレーション・サポート
背景:
- 左心室補助器 (LVAD) を用いた移植へのブリッジ治療は,心臓移植 (HT) を待っている末期心不全患者の重要な治療法です.
- 現在のHTリストの基準は,医学的管理と機械的にブリッジされた患者を区別していません.
- この研究では,LVADでサポートされたBTTがHT後の生存および死亡リスク因子に与える影響を調査しています.
研究 の 目的:
- 心臓移植後の生存率に対するBTTとLVADの効果を評価する.
- 医学的に管理されたと機械的にブリッジされたHT受容者間の1年間の死亡の原因を比較する.
- LVADを投与した患者と投与されなかった患者の1年死亡率に関連した危険因子を特定する.
主な方法:
- 臓器共有ネットワークのデータベースを利用して 2008年から2015年にかけて5486人の成人単体臓器受容者を分析した.
- HTでのLVAD使用の可能性を考慮する使用傾向のマッチング
- カプラン- メイヤー生存分析とロジスティック回帰では,1年および5年での死亡率とリスク因子の確率を評価した.
主要な成果:
- 機械的にブリッジされた患者は,医学的に管理された患者 (7. 2%) と比較して,より高い早期死亡率 (9. 5%) を示した.
- BTT患者の1年死亡リスクの増加は,推定グルメルフィルタレーション率が40- 60mL·min−1. 73m−2から40mL·min−1. 73m−2以下であった.
- 体重指数 (25~30kg/m2および>30kg/m2) は,BTT患者における死亡リスクの増加とも相関していた.
結論:
- LVADでサポートされたBTTは臓器不足による待機リストの生存率を向上させますが,早期の移植後の死亡リスクを大幅に増加させます.
- 機械的なサポートで橋渡しされた患者は,LVADの植入後の移植適性について細心の評価が必要です.
- 年齢,腎機能,BMIなどの要因を考慮したリスクの階層化は,BTT患者の管理に不可欠です.
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