Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; The Haemodynamic Lab, The Clinic for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.
Transpl Int. 2014 May;27(5):482-92. doi: 10.1111/tri.12284. Epub 2014 Mar 26.
Acute cellular rejection (ACR) the first year after heart transplantation (HT) and its impact on survival was investigated. All 215 HT patients at our centre 1988-2010, including 219 HTs and 2990 first-year endomyocardial biopsies (EMBs), were studied. 'Routine' EMBs obtained 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40 and 52 weeks after HT, and 'additional clinically indicated' (ACI) EMBs, were graded according to the 1990-ISHLT-WF. The frequency and severity of first-year ACRs was low, with 6.5% of routine EMBs and 14.1% of ACI EMBs showing ACR ≥ grade 2. Proportionally more (P < 0.05) first-year ACRs ≥ grade 2 were found among EMBs in HTs performed during 1988-1999 (9.6%) than 2000-2010 (5.5%), EMBs performed during 16-52 weeks (8.8%) than 1-12 weeks (6.3%) after HT, EMBs in HTs with paediatric (11.3%) than adult (7.1%) donors, and EMBs in sex-mismatched (10.4%) than sex-matched (6.3%) HTs. Five- and ten-year survival was furthermore lower (P < 0.05) among HTs with ≥ 1 compared with 0 first-year ACRs ≥ grade 3A/3B (82% vs. 92% and 69% vs. 82%, respectively). Ten-year survival was 74% compared with 53% in the ISHLT registry. In conclusion, our results indicate that first-year ACRs ≥ grade 3A/3B affect long-term survival. We believe frequent first-year EMBs may allow early ACR detection and continuous immunosuppressive adjustments, preventing low-grade ACRs from progressing to ACRs ≥ grade 3A/3B, thereby improving survival.
研究了心脏移植（HT）后第一年的急性细胞排斥（ACR）及其对生存率的影响。我们中心 1988 年至 2010 年的 215 例 HT 患者，包括 219 例 HT 和 2990 例第一年的心肌活检（EMB），均进行了研究。“常规”EMB 在 HT 后 1、2、3、4、6、8、10、12、16、20、24、32、40 和 52 周获得，“额外临床指示”（ACI）EMB 根据 1990-ISHLT-WF 进行分级。第一年 ACR 的频率和严重程度较低，常规 EMB 中有 6.5%和 ACI EMB 中有 14.1%的 ACR≥2 级。在 1988-1999 年（9.6%）进行的 HT 中，发现更多的（P<0.05）比例的第一年内 ACR≥2 级的 EMB，而在 2000-2010 年（5.5%）中，在 HT 后 1-12 周（6.3%）进行的 EMB 中，在 HT 中接受儿科（11.3%）而不是成人（7.1%）供体的 EMB 中，在 HT 中接受性别不匹配（10.4%）而不是性别匹配（6.3%）的 EMB 中，发现更多的比例。与 0 相比，有≥1 例第一年 ACR≥3A/3B 的 HT 的五年和十年生存率进一步降低（P<0.05）（分别为 82% vs. 92%和 69% vs. 82%）。与 ISHLT 登记处相比，十年生存率为 74%。总之，我们的结果表明，第一年 ACR≥3A/3B 会影响长期生存率。我们认为，频繁的第一年 EMB 可能会早期发现 ACR，并进行持续的免疫抑制调整，防止低级别 ACR 进展为 ACR≥3A/3B，从而提高生存率。
