Malickaite Radvile, Rucinskas Kestutis, Staneviciene Aldona, Miniauskas Saulius, Maneikiene Vyte, Zuoziene Gitana, Sirvydis Vytautas
Vilnius University, Vilnius, Lithuania.
Interact Cardiovasc Thorac Surg. 2009 Mar;8(3):339-42; discussion 342-3. doi: 10.1510/icvts.2008.192567. Epub 2008 Dec 19.
The purpose of this study was to evaluate sensitisation, occurring because of bridging with VAD, and development of rejection episodes after transplantation in selected groups of patients using triple drug immunosuppression, without induction or desensitisation therapy. Sensitisation using standard complement dependent cytotoxicity was tested in 16 patients awaiting cardiac transplantation before VAD placement, one month post-implantation and on a six-monthly basis later on. Long-term (955+/-998 days) post-transplant course of six transplanted post-VAD patients was compared with 19 non-bridged recipients (follow-up time 1425+/-1273 days) of the same age. One-third of VAD recipients had developed anti-HLA antibodies one month post-implantation; 4/16 patients were sensitised six months after implantation. No de novo sensitisation development was revealed in VAD group post-transplantation. All sensitised patients independent of VAD placement underwent graft rejection episodes. Only 1 of 6 VAD recipient was treated because of grade 2R rejection, compared to 6/19 in the non-bridged group, P=0.63. None of the patients had failed because of early graft rejection. In conclusion, VAD devices used in our centre cause low level risk for anti-HLA antibodies development. There were no differences in survival due to immunologic reasons between VAD bridged and non-bridged patients.
本研究的目的是评估在未进行诱导或脱敏治疗的情况下，使用三联药物免疫抑制的特定患者群体中，因与心室辅助装置（VAD）桥接而发生的致敏反应以及移植后排斥反应的发生情况。对16例等待心脏移植的患者在植入VAD前、植入后1个月以及之后每6个月进行一次标准补体依赖细胞毒性试验以检测致敏情况。将6例VAD植入后接受移植患者的长期（955±998天）移植后病程与19例同龄非桥接受者（随访时间1425±1273天）进行比较。三分之一的VAD接受者在植入后1个月产生了抗HLA抗体；16例患者中有4例在植入后6个月致敏。VAD组移植后未发现新发致敏情况。所有致敏患者，无论是否植入VAD，均发生了移植排斥反应。6例VAD接受者中只有1例因2R级排斥反应接受治疗，非桥接组为19例中的6例，P = 0.63。没有患者因早期移植排斥反应而失败。总之，我们中心使用的VAD装置导致产生抗HLA抗体的风险较低。VAD桥接患者和非桥接患者因免疫原因导致的生存率没有差异。
