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在循环死亡 (DCD) 心脏移植后捐赠的急性拒绝

Selena S Li¹, Masaki Funamoto², Asishana A Osho¹

¹Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

|September 17, 2023

概括

循环死亡 (DCD) 心脏移植后的捐赠显示出与脑死亡 (DBD) 移植后的捐赠相似的早期存活率,但DCD接受者面临急性排斥的更高风险. 需要进一步研究长期结果.

科学领域:

心脏病学心脏病学
移植医学移植医学
免疫学免疫学免疫学

背景情况:

循环死亡 (DCD) 心脏移植后的捐赠有可能增加器官的可用性.
DCD心脏移植的早期生存率是有希望的.
DCD对急性排斥的影响仍然是一个需要进一步澄清的领域.

研究的目的:

为了比较DCD和DBD捐赠者之间成人心脏移植接受者中急性排斥的发生率.
确定DCD与DBD心脏移植接受者急性排斥的预测因子.

主要方法:

对2019年12月至2021年12月期间成年人心脏移植的联合器官共享网络数据库的分析.
排除多器官移植和失去随访的患者.
主要结局:急性排斥,比较DCD和脑死亡后捐赠 (DBD) 队列.

主要成果:

与DBD接受者 (n=5,582) 相比,DCD接受者 (n=292) 不太可能需要机械支持 (IABP,ECMO,LVAD) 或在移植前入院.
在15个月的随访中,DCD接受者在出院前出现急性排斥 (23.3%对18.4%) 和因排斥住院 (23.4%对11.4%) 的可能性更高.
DCD捐赠独立预测了急性排斥 (OR 1.47) 和因排斥而住院 (OR 2.03),在子组分析中观察到的比率更高.

结论:

与DBD接受者相比,DCD心脏移植接受者出现急性排斥的发生率明显高.
虽然早期的存活率是可比的,但DCD接受者的早期排斥率增加需要进一步研究长期影响.
这些发现表明需要优化免疫抑制方案或对DCD心脏移植接受者进行更密切的监测.

关键词:

在DCD心脏移植手术中,DCD移植结果的结果急性排斥急性排斥在循环死亡后的捐赠.心脏移植心脏移植的心脏移植心脏移植结果的结果

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