在高度敏感的心脏移植候选人的脱敏治疗后的影响和结果
Rashmi Jain1, Andriana Nikolova1, Michelle Kittleson1
1Cedars-Sinai Medical Center, Smidt Heart Institute, Department of Cardiology, Los Angeles, California, USA.
概括
脱敏疗法显著降低了高度敏感的心脏移植 (HT) 候选人的抗体,使更多的移植成为可能. 虽然抗体中介排斥率较高,但长期存活率和移植功能与一般HT人群相比仍然相当.
科学领域:
- 免疫学 免疫学 免疫学
- 心脏病学 心脏病学
- 移植医学 移植医学
背景情况:
- 高度敏感的患者因抗人类白细胞抗原 (HLA) 抗体而面临接受心脏移植的挑战.
- 这种人群中脱敏治疗的疗效和结果在很大程度上是未知的.
- 移植前的抗体水平,特别是计算的面板反应性抗体 (cPRA) >50%与平均光强度 (MFI) >10,000,构成重大障碍.
研究的目的:
- 评估脱敏方案在降低高度敏感心脏移植候选人的抗体水平方面的有效性.
- 评估移植后的结果,包括排斥率,移植功能,存活率和安全性,在脱敏治疗后.
- 确定脱敏疗法是否扩大了捐赠者群,并为符合条件的候选人提供了心脏移植.
主要方法:
- 对57名高度敏感的心脏移植候选人的回顾性队列研究 (cPRA>50%,MFI>10,000).
- 患者接受了使用博尔特佐米布/血酶或rituximab/obinutuzumab与静脉注射免疫球蛋白的脱敏疗法.
- 通过医疗记录审查评估了治疗后的cPRA,捐赠者特异性抗体 (DSA) 和临床结果.
主要成果:
- 脱敏疗法显著降低了MFI>10,000和/或C1q阳性抗体的抗体的cPRA.
- 40名患者在脱敏后接受了心脏移植.
- 17名移植患者减少或消除了DSAs,使以前不可能的移植成为可能.
- 与全国HT人群相比,移植患者的抗体中介排斥率较高,但5年生存率和移植结果相似.
- 安全结果 (恶性病,感染) 在可接受的范围内.
结论:
- 脱敏疗法有效降低高度敏感的心脏移植候选人的抗体水平.
- 这些疗法扩大了捐赠者群,并促进了心脏移植.
- 虽然抗体中介排斥率可能会增加,但脱敏感化提供了一个可行的选择,具有可比的长期存活率和移植功能.
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