1型血管紧张素II受体抗体对Heart Mate II过渡性受者心脏移植术后结局的影响。
The impact of angiotensin II type 1 receptor antibodies on post-heart transplantation outcome in Heart Mate II bridged recipients.
作者信息
Urban Marian, Slavcev Antonij, Gazdic Tomas, Ivak Peter, Besik Josef, Netuka Ivan
机构信息
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Department of Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
出版信息
Interact Cardiovasc Thorac Surg. 2016 Mar;22(3):292-7. doi: 10.1093/icvts/ivv344. Epub 2015 Dec 15.
OBJECTIVES
Antibodies targeting angiotensin II type 1 receptor (AT1R) have been associated with malignant hypertension, autoimmune diseases and acute rejection and graft loss in solid organ transplantation. The aim of our study was to assess the impact of anti-AT1R antibodies on survival and incidence of acute cellular rejection (ACR) and pathology antibody-mediated rejection (pAMR) in a population of heart transplant recipients who were bridged to transplantation with a durable mechanical assist device Heart Mate II.
METHODS
Sera of 69 consecutive heart transplant recipients transplanted between October 2008 and August 2014 were tested for the presence of angiotensin II type 1 receptor antibodies before Heart Mate II device implantation and at the time of transplantation. Overall survival and post-transplant rejection-free survival were compared between antibody-negative and antibody-positive recipients using Kaplan-Meier and log-rank tests.
RESULTS
Anti-AT1R antibodies were present in 8 patients (11.6%) before Heart Mate II implantation. During the left ventricular assist device (LVAD) bridging, 44 patients (63.8%) who were initially anti-AT1R antibody-negative became positive, leaving 17 (24.6%) anti-AT1R antibody-negative patients at the time of transplantation for all comparisons. One- and 5-year survival was 88 ± 8 and 76 ± 10% for anti-AT1R antibody-negative and 87 ± 5 and 81 ± 7% for anti-AT1R antibody-positive patients, respectively (P = 0.582). Freedom from ACR at 1 year was 68 ± 12% for anti-AT1R-negative and 75 ± 6% for anti-AT1R-positive recipients (P = 0.218). None of the anti-AT1R-negative patients developed AMR 1 year post-transplantation, whereas freedom from pAMR in anti-AT1R-positive recipients was 98 ± 2% (P = 0.198).
CONCLUSIONS
Our data showed no difference in the overall post-heart transplant survival and freedom from acute cellular and antibody-mediated rejection between anti-AT1R-negative and anti-AT1R-positive recipients. Further research is needed to assess the role of anti-AT1R antibodies in the risk stratification of LVAD-bridged recipients on the post-heart transplantation outcomes.
目的
靶向血管紧张素II 1型受体（AT1R）的抗体与恶性高血压、自身免疫性疾病以及实体器官移植中的急性排斥反应和移植失败有关。我们研究的目的是评估抗AT1R抗体对使用持久机械辅助装置Heart Mate II过渡到移植的心脏移植受者群体的生存率、急性细胞排斥反应（ACR）发生率和病理抗体介导的排斥反应（pAMR）的影响。
方法
对2008年10月至2014年8月期间连续进行心脏移植的69例受者在植入Heart Mate II装置前和移植时检测血清中血管紧张素II 1型受体抗体的存在情况。使用Kaplan-Meier法和对数秩检验比较抗体阴性和抗体阳性受者的总生存率和移植后无排斥反应生存率。
结果
8例患者（11.6%）在植入Heart Mate II前存在抗AT1R抗体。在左心室辅助装置（LVAD）过渡期间，44例最初抗AT1R抗体阴性的患者（63.8%）转为阳性，移植时共有17例（24.6%）抗AT1R抗体阴性患者用于所有比较。抗AT1R抗体阴性患者1年和5年生存率分别为88±8%和76±10%，抗AT1R抗体阳性患者分别为87±5%和81±7%（P = 0.582）。抗AT1R阴性受者1年时无ACR的比例为68±12%，抗AT1R阳性受者为75±6%（P = 0.218）。抗AT1R阴性患者移植后1年均未发生AMR，而抗AT1R阳性受者无pAMR的比例为98±2%（P = 0.198）。
结论
我们的数据显示，抗AT1R阴性和抗AT1R阳性受者在心脏移植后的总体生存率以及急性细胞排斥反应和抗体介导的排斥反应方面没有差异。需要进一步研究以评估抗AT1R抗体在LVAD过渡受者心脏移植后结局风险分层中的作用。
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