Alba Ana C, Tinckam Kathryn, Foroutan Farid, Nelson Laerke M, Gustafsson Finn, Sander Kam, Bruunsgaard Hellen, Chih Sharon, Hayes Helen, Rao Vivek, Delgado Diego, Ross Heather J
Heart Failure and Transplantation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Heart Failure and Transplantation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
J Heart Lung Transplant. 2015 May;34(5):685-92. doi: 10.1016/j.healun.2014.11.024. Epub 2014 Dec 8.
One major disadvantage of ventricular assist device (VAD) therapy is the development of human-leukocyte antigen (HLA) antibodies. We aimed to identify factors associated with HLA antibodies during continuous flow (CF)-VAD support and assess the effect on transplant probability and outcomes.
We included 143 consecutive heart failure patients who received a CF-VAD as a bridge-to-transplant at 3 institutions. Factors associated with post-VAD peak panel reactive antibodies (PRA) among several measurements were identified using multivariable linear regression. A parametric survival model was used to assess transplant waiting time and probability, risk of rejection, and a composite outcome of rejection, graft failure, and death.
Thirty-six patients (25%) were female; mean age was 47 ± 13 years. Eighty-one patients (57%) had a pre-VAD PRA of 0%, and 16 were highly sensitized (PRA > 80%). Age, female sex, and pre-VAD PRA were independently associated with post-VAD PRA. A 10-year increase in age was associated with a 5% decrease in post-VAD PRA (p = 0.03). Post-VAD PRA was 19% higher in women vs men (p < 0.01). A 10%-increase in pre-VAD PRA was associated with a 4.7% higher post-VAD PRA (p < 0.01). During a mean follow-up of 12 ± 11 months, 90 patients underwent cardiac transplantation. A 20% increase in post-VAD PRA was associated with 13% lower probability of transplant (hazard ratio, 0.87; 95% confidence interval, 0.76-0.99). A high PRA was not associated with adverse post-transplant outcomes.
Younger age, female sex, and pre-VAD PRA were independent predictors of elevated PRA post-VAD. Higher PRA was significantly associated with lower transplant probability but not increased rejection, graft failure, or death after transplant.
心室辅助装置（VAD）治疗的一个主要缺点是产生人类白细胞抗原（HLA）抗体。我们旨在确定持续血流（CF）-VAD支持期间与HLA抗体相关的因素，并评估其对移植概率和结果的影响。
我们纳入了143例连续的心力衰竭患者，这些患者在3家机构接受CF-VAD作为移植桥梁。使用多变量线性回归确定在多项测量中与VAD后峰值群体反应性抗体（PRA）相关的因素。使用参数生存模型评估移植等待时间和概率、排斥风险以及排斥、移植物失败和死亡的复合结局。
36例患者（25%）为女性；平均年龄为47±13岁。81例患者（57%）VAD前PRA为0%，16例高度致敏（PRA>80%）。年龄、女性性别和VAD前PRA与VAD后PRA独立相关。年龄每增加10岁，VAD后PRA降低5%（p=0.03）。女性的VAD后PRA比男性高19%（p<0.01）。VAD前PRA每增加10%，VAD后PRA高4.7%（p<0.01）。在平均12±11个月的随访期间，90例患者接受了心脏移植。VAD后PRA增加20%与移植概率降低13%相关（风险比，0.87；95%置信区间，0.76-0.99）。高PRA与移植后不良结局无关。
年龄较小、女性性别和VAD前PRA是VAD后PRA升高的独立预测因素。较高的PRA与较低的移植概率显著相关，但与移植后排斥反应增加、移植物失败或死亡无关。
