Hiemann Nicola Erika, Knosalla Christoph, Wellnhofer Ernst, Lehmkuhl Hans Brendan, Hetzer Roland, Meyer Rudolf
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Transpl Immunol. 2008 Jul;19(3-4):209-14. doi: 10.1016/j.trim.2008.06.003. Epub 2008 Jul 9.
We tested if Quilty (endocardial infiltration of lymphocytes) in routinely processed endomyocardial biopsy is associated with poor outcome after heart transplantation (HTx). Biopsies (n=9829) harvested within the first post-transplant year from 938 patients (778 men, mean age 49 years) were evaluated for Quilty and acute cellular rejection (according to the International Society for Heart and Lung Transplantation, ISHLT, classification). Transplant vasculopathy was evaluated by coronary angiography, and severe stenosis was found in 19% of patients. Survival was tested by Kaplan-Meier and Cox regression analyses for all-cause mortality and major cardiac events (lethal acute cellular rejection, graft loss or myocardial infarction). We found 1840 (19%) Quilty-positive biopsies in 487 Quilty-positive patients (52%). Quilty was more prevalent in women (p=0.038) and younger men (p=0.001), and was correlated with ISHLT grade 1R (OR 1.45, 95% CI 1.36-1.55; p<0.001) and ISHLT grade 2R (OR 2.48, 95% CI 2.21-3.41; p<0.001). Quilty in any biopsy was associated with a higher all-cause mortality (log rank p=0.045) due to a higher risk for major cardiac event (p=0.0001). Multivariate regression analysis showed Quilty (RR 1.69, 95%CI 1.05-2.73) and transplant vasculopathy (RR 2.78, 95%CI 1.68-4.61) as risk factors for major cardiac events and treated hyperlipidemia as lowering the risk for major cardiac events (RR 0.47, 95%CI 0.28-0.77). Quilty is associated with graft loss and poor outcome post HTx. Index biopsy during the first post-transplant year is a useful tool to identify patients at risk and is recommended during routine post-transplant management.
我们测试了常规处理的心内膜心肌活检中的奎尔蒂病变（淋巴细胞心内膜浸润）是否与心脏移植（HTx）后预后不良相关。对938例患者（778例男性，平均年龄49岁）在移植后第一年内采集的活检样本（n = 9829）进行奎尔蒂病变和急性细胞排斥反应评估（根据国际心肺移植学会，ISHLT分类）。通过冠状动脉造影评估移植血管病变，19%的患者发现严重狭窄。通过Kaplan-Meier法和Cox回归分析对全因死亡率和主要心脏事件（致命性急性细胞排斥反应、移植物丢失或心肌梗死）进行生存测试。我们在487例（52%）奎尔蒂病变阳性患者中发现1840例（19%）活检样本奎尔蒂病变阳性。奎尔蒂病变在女性中更常见（p = 0.038），在年轻男性中也更常见（p = 0.001），并且与ISHLT 1R级（OR 1.45，95%CI 1.36 - 1.55；p < 0.001）和ISHLT 2R级（OR 2.48，95%CI 2.21 - 3.41；p < 0.001）相关。任何活检中的奎尔蒂病变都与较高的全因死亡率相关（对数秩检验p = 0.045），因为主要心脏事件风险较高（p = 0.0001）。多变量回归分析显示，奎尔蒂病变（RR 1.69，95%CI 1.05 - 2.73）和移植血管病变（RR 2.78，95%CI 1.68 - 4.61）是主要心脏事件的危险因素，而接受治疗的高脂血症则降低主要心脏事件风险（RR 0.47，95%CI 0.28 - 0.77）。奎尔蒂病变与移植物丢失和心脏移植后不良预后相关。移植后第一年内的索引活检是识别高危患者的有用工具，建议在常规移植后管理中进行。
