Drakos Stavros G, Stringham James C, Long James W, Gilbert Edward M, Fuller Thomas C, Campbell Beverly K, Horne Benjamin D, Hagan Mary E, Nelson Karl E, Lindblom Judy M, Meldrum Patty A, Carlson Joanne F, Moore Stephanie A, Kfoury Abdallah G, Renlund Dale G
Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Salt Lake City, Utah, USA.
J Thorac Cardiovasc Surg. 2007 Jun;133(6):1612-9. doi: 10.1016/j.jtcvs.2006.11.062.
Allosensitization of left ventricular assist device recipients has been associated with perioperative transfusion of cellular blood products. The relative sensitizing contribution of leukofiltered cellular blood products, however, remains unclear. We investigated the pattern of sensitization in left ventricular assist device recipients in relation to cellular blood product transfusions received.
Seventy-one consecutive nonsensitized recipients of the HeartMate left ventricular assist device (Thoratec Corporation, Pleasanton, Calif) as a bridge to transplantation were reviewed. Panel-reactive HLA antibody levels at consecutive times after device implantation were correlated with perioperative cellular blood product transfusions.
Fifty-four patients received leukofiltered cellular blood products (transfused), whereas 17 patients received only fresh-frozen plasma (nontransfused). Among nontransfused patients, 58.8% (10/17) became sensitized during mechanical support, versus 35.2% of transfused patients (19/54, P = .15). There was a trend toward more sensitization during the 12 weeks after device placement in nontransfused patients. Kaplan-Meier analysis revealed significantly more sensitization in nontransfused patients than in transfused patients, despite equal rates of transplantation (P = .05). A dose-response analysis revealed significant trends toward less sensitization and lower peak panel-reactive antibody level with more cellular blood product transfusions (P = .04). Multivariate Cox regression revealed only increasing transfusions to be associated with a reduced risk of sensitization (hazard ratio 0.18, P = .01).
Sensitization becomes more prevalent with increasing length of support. Avoidance of perioperative leukocyte-filtered cellular blood product transfusions does not decrease the incidence or degree of HLA sensitization. Conversely, cellular blood product transfusions may be associated with lessened alloimmunization and may mitigate the sensitization seen in recipients of the HeartMate left ventricular assist device as a bridge to transplantation.
左心室辅助装置接受者的同种异体致敏与围手术期输注细胞血液制品有关。然而，白细胞滤除的细胞血液制品的相对致敏作用仍不清楚。我们研究了左心室辅助装置接受者的致敏模式与所接受的细胞血液制品输注之间的关系。
回顾了71例连续接受HeartMate左心室辅助装置（Thoratec公司，加利福尼亚州普莱森顿）作为移植桥梁的未致敏接受者。装置植入后连续时间的群体反应性HLA抗体水平与围手术期细胞血液制品输注相关。
54例患者接受了白细胞滤除的细胞血液制品（输血组），而17例患者仅接受新鲜冷冻血浆（未输血组）。在未输血患者中，58.8%（10/17）在机械支持期间致敏，而输血患者为35.2%（19/54，P = 0.15）。未输血患者在装置置入后12周内有更高的致敏趋势。Kaplan-Meier分析显示，尽管移植率相同，但未输血患者的致敏率明显高于输血患者（P = 0.05）。剂量反应分析显示，随着细胞血液制品输注量增加，致敏率降低和群体反应性抗体峰值水平降低的趋势显著（P = 0.04）。多变量Cox回归显示，仅输注量增加与致敏风险降低相关（风险比0.18，P = 0.01）。
随着支持时间延长，致敏变得更为普遍。避免围手术期输注白细胞滤除的细胞血液制品不会降低HLA致敏的发生率或程度。相反，细胞血液制品输注可能与同种免疫减少有关，并可能减轻作为移植桥梁的HeartMate左心室辅助装置接受者的致敏。
