Sobieszczańska-Małek Małgorzata, Zieliński Tomasz, Korewicki Jerzy
Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland.
Ann Transplant. 2007;12(4):38-43.
This study was an attempt to identify donor-related factors influencing the frequency of acute cellular rejection episodes in cardiac transplant recipients in the first year following transplantation.
MATERIAL/METHODS: The study encompassed 76 patients (14 women and 62 men) aged 6-68 years, mean 47.8+/-16.3, who received a cardiac transplant at the Institute of Cardiology in Warsaw between 2001-2005. The period of observation was from day 7 after transplantation (the day of the first biopsy by protocol) to the end of the first year. Follow-up at the outpatient department included physical examination, echocardiography, blood biochemistry and determination of circulating levels of immunosuppressive drugs. Endomyocardial biopsies were obtained and evaluated according to ISHLT criteria. The study was conducted according to the following biopsy schedule: every 7 days in the first month, every 14 days in the second, and every three months from month three to the end of the first year. The frequency of acute cellular rejection was assessed along with potential donor-related factors (age, gender, donor cause of death). The study protocol was approved by the Local Bioethics Committee of the Institute of Cardiology. Comparative statistical analysis was conducted retrospectively using the Mann-Whitney and Kruskal-Wallis tests.
A total of 39 abnormal biopsies were found (degree 2 and 3 ISHLT) among the 750 biopsies performed (5.2%). No significant differences were found in the number of acute cellular rejection episodes in relation to treatment protocol and blood cyclosporine concentration in the studied period. Acute cellular rejection was occured significantly more frequently when intracerebral hemorrhage was the donor's cause of death (p<0.0131) and showed a tendency to occur more frequently when the donor was female (p<0.0611). The effects of donor age, blood type and duration of ischemia were not significant.
Significantly more episodes of acute cellular rejection occur in recipients of hearts from donors who died from intracerebral hemorrhage. A trend towards more frequent episodes of acute cellular rejection appears when the donor was female.
本研究旨在确定影响心脏移植受者移植后第一年急性细胞排斥反应发作频率的供体相关因素。
材料/方法：本研究纳入了76例年龄在6至68岁之间（平均47.8±16.3岁）的患者（14名女性和62名男性），他们于2001年至2005年期间在华沙心脏病学研究所接受了心脏移植。观察期从移植后第7天（按方案进行首次活检的日期）至第一年末。门诊随访包括体格检查、超声心动图、血液生化检查以及免疫抑制药物循环水平的测定。获取心内膜活检组织并根据国际心脏和肺移植学会（ISHLT）标准进行评估。本研究按照以下活检时间表进行：第一个月每7天进行一次，第二个月每14天进行一次，从第三个月至第一年末每三个月进行一次。评估急性细胞排斥反应的频率以及潜在的供体相关因素（年龄、性别、供体死因）。本研究方案经心脏病学研究所当地生物伦理委员会批准。使用曼-惠特尼检验和克鲁斯卡尔-沃利斯检验进行回顾性比较统计分析。
在进行的750次活检中，共发现39次异常活检（ISHLT 2级和3级）（5.2%）。在研究期间，急性细胞排斥反应发作次数与治疗方案和血液中环孢素浓度之间未发现显著差异。当供体死因为脑出血时，急性细胞排斥反应的发生频率显著更高（p<0.0131），并且当供体为女性时，急性细胞排斥反应有更频繁发生的趋势（p<0.0611）。供体年龄、血型和缺血持续时间的影响不显著。
死于脑出血的供体心脏受者发生急性细胞排斥反应的次数明显更多。当供体为女性时，急性细胞排斥反应发作更频繁的趋势显现。
