UTAH (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program, University of Utah, Salt Lake City, Utah 84132, USA.
Ann Thorac Surg. 2011 Nov;92(5):1601-7; discussion 1607. doi: 10.1016/j.athoracsur.2011.05.119. Epub 2011 Sep 22.
Both pulsatile-flow and continuous-flow left ventricular assist devices (LVADs) successfully provide patients a bridge to transplantation. Some data suggest that continuous-flow pumps increase the risk of allograft rejection, contributing to posttransplantation morbidity and mortality. We sought to analyze the relationship between LVAD flow characteristics and subsequent allograft rejection in bridge to transplant (BTT) patients.
Patients with LVADs from the UTAH Transplant Affiliated Hospitals were retrospectively analyzed. Rejection was determined pathologically according to the International Society for Heart and Lung Transplantation revised cardiac allograft rejection scale. Multimodal statistical analyses were applied.
Of 1,076 patients who underwent transplantation over a 26-year period, 151 had LVADs. Of these, 111 (77 pulsatile flow, 34 continuous flow) patients had pathologic data available. There was no difference in overall rejection (grades 1R to 3R) between the pulsatile-flow LVAD and continuous-flow LVAD groups (2.00 ± 1.43 versus 1.50 ± 1.16 episodes/year; p = 0.076.) Patients with pulsatile-flow LVADs had more clinically relevant (grades 2R to 3R) rejection than did patients with continuous-flow LVADs (0.49 ± 0.72 versus 0.12 ± 0.33 episodes/year; p < 0.001). There was no survival difference at 1 year (p = 0.920) or 4 years (p = 0.721) after transplantation.
Patients with continuous-flow LVADs have similar overall rejection rates and a reduced rate of clinically relevant rejection compared with patients with pulsatile-flow LVADs during the first year after transplantation. Although there is theoretical concern that nonphysiologic, nonpulsatile flow could alter the neurohormonal profile of patients in heart failure, we are encouraged that the type of LVAD circulation does not influence posttransplantation allograft survival.
搏动流和连续流左心室辅助装置（LVAD）都成功地为患者提供了移植的桥梁。一些数据表明，连续流泵增加了同种异体移植排斥的风险，导致移植后发病率和死亡率增加。我们试图分析 LVAD 流量特征与桥接移植（BTT）患者随后发生同种异体移植排斥之间的关系。
对来自犹他州移植附属医院的 LVAD 患者进行回顾性分析。根据国际心肺移植协会修订的心脏同种异体移植排斥标准，通过病理学确定排斥反应。应用多模态统计分析。
在 26 年的时间里，共有 1076 名患者接受了移植，其中 151 名患者使用了 LVAD。在这些患者中，有 111 名（77 名搏动流，34 名连续流）患者有病理学数据。搏动流 LVAD 和连续流 LVAD 组之间的总体排斥反应（1R 至 3R 级）没有差异（2.00 ± 1.43 与 1.50 ± 1.16 次/年；p = 0.076）。与连续流 LVAD 组相比，搏动流 LVAD 组患者的临床相关（2R 至 3R 级）排斥反应更多（0.49 ± 0.72 与 0.12 ± 0.33 次/年；p < 0.001）。移植后 1 年（p = 0.920）和 4 年（p = 0.721）的生存率无差异。
与搏动流 LVAD 组相比，在移植后第一年，连续流 LVAD 组患者的总体排斥反应率相似，且临床相关排斥反应的发生率较低。尽管理论上担心非生理、非搏动流会改变心力衰竭患者的神经激素谱，但我们感到鼓舞的是，LVAD 循环的类型不会影响移植后同种异体移植物的存活。
