Pagani F D, Dyke D B, Wright S, Cody R, Aaronson K D
Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.
J Heart Lung Transplant. 2001 Jun;20(6):646-53. doi: 10.1016/s1053-2498(01)00232-7.
Previous reports have indicated that antibodies to HLA class I or II antigens develop in approximately 60% of patients following left ventricular assist device (LVAD) implantation, subsequent rates of allograft rejection are higher, and survival is adversely affected.
We performed an analysis of the incidence of antibody development to HLA class I or II antigens by panel reactive antibody (PRA) screening following implantation of the HeartMate LVAD in 38 patients from October 1, 1996 to March 1, 2000 (6 LVAD deaths excluded from study). The occurrence of vascular or cellular rejection of International Society of Heart and Lung Transplantation grade > or = 3A, as determined by endomyocardial biopsy following heart transplantation (HTX), were compared for patients with (n = 32, LVAD group) or without (n = 68, control group) preoperative LVAD support.
After LVAD implantation, 9 patients (28%) in the LVAD group developed IgG antibodies to class I (n = 3), class II (n = 5), or both antigens (n = 1) with PRA > 10%. The remaining 23 patients (72%) had either no detectable IgG antibody development or IgG antibody development with PRA < 10%. At the time of HTX, only 4 patients in the LVAD group had persistent PRA > 10%. Only 3 patients (4%) in the control group had PRA > 10% at the time of HTX. The incidence of patients free from rejection at 6 and 12 months was 62% and 44% for the control group, and 49%, and 40% for the LVAD group, respectively (p not significant). The mean linearized rate plus or minus standard deviation of allograft rejection from 0 to 6 months and 7 to 12 months was 0.13 +/- 0.21 and 0.09 +/- 0.14 episodes a month, respectively, for patients with no LVAD support, and 0.17 +/-.25 and 0.06 +/- 0.1 episodes a month, respectively, for those with LVAD support (p = not significant). Post-transplantation survival at 1 and 2 years was 90% and 90%, respectively, for the control group, and 97% and 92%, respectively, for the LVAD group (p not significant).
Patients with LVAD support before HTX do not appear to be at increased risk for significant allograft rejection in the first year or for death within the first 2 years after transplantation.
既往报道表明，约60%的患者在植入左心室辅助装置（LVAD）后会产生针对人类白细胞抗原（HLA）Ⅰ类或Ⅱ类抗原的抗体，随后同种异体移植排斥反应的发生率更高，且生存受到不利影响。
我们对1996年10月1日至2000年3月1日期间植入HeartMate LVAD的38例患者（6例LVAD死亡患者被排除在研究之外）进行了群体反应性抗体（PRA）筛查，以分析针对HLAⅠ类或Ⅱ类抗原的抗体产生情况。对心脏移植（HTX）后经心内膜活检确定为国际心肺移植学会分级>或 = 3A的血管性或细胞性排斥反应的发生情况，在术前接受LVAD支持的患者（n = 32，LVAD组）和未接受LVAD支持的患者（n = 68，对照组）之间进行了比较。
LVAD植入后，LVAD组9例患者（28%）产生了针对Ⅰ类（n = 3）、Ⅱ类（n = 5）或两种抗原（n = 1）的IgG抗体，PRA>10%。其余23例患者（72%）未检测到IgG抗体产生或IgG抗体产生时PRA<10%。在HTX时，LVAD组只有4例患者的PRA持续>10%。对照组在HTX时只有3例患者（4%）的PRA>10%。对照组6个月和12个月时无排斥反应患者的发生率分别为62%和44%，LVAD组分别为49%和40%（p无统计学意义）。无LVAD支持的患者从0至6个月和7至12个月的同种异体移植排斥反应的平均线性化率加或减标准差分别为每月0.13±0.21次和0.09±0.14次，接受LVAD支持的患者分别为每月0.17±0.25次和0.06±0.1次（p无统计学意义）。对照组移植后1年和2年的生存率分别为90%和90%，LVAD组分别为97%和92%（p无统计学意义）。
HTX前接受LVAD支持的患者在移植后第一年发生严重同种异体移植排斥反应或移植后2年内死亡的风险似乎并未增加。
