成人囊性纤维化患者肺移植前群体反应性抗体与移植后生存率
Pre-transplant Panel Reactive Antibody and Survival in Adult Cystic Fibrosis Patients After Lung Transplantation.
作者信息
Hayes Don, Tumin Dmitry, Tobias Joseph D
机构信息
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
出版信息
Lung. 2016 Jun;194(3):429-35. doi: 10.1007/s00408-016-9861-8. Epub 2016 Mar 2.
BACKGROUND
Survival implications of pre-transplant antibodies to human leukocyte antigens prior to lung transplantation (LTx) in adult cystic fibrosis (CF) patients are unknown.
METHODS
Data from the United Network for Organ Sharing Registry (1987-2013) were used to compare survival differences in adult CF patients with pre-transplant class I and II panel reactive antibody (PRA) levels ≤10 versus >10 %.
RESULTS
Of 3149 CF LTx recipients, 1526 and 1399 were included in univariate survival analyses of class I and II PRA, respectively, while 1106 and 1001 were included in multivariate Cox analyses for class I and class II, respectively. Kaplan-Meier survival functions failed to demonstrate significant differences in survival with PRA >10 % for class I (Log-rank test: χ (2) (df = 1): 1.11, p = 0.293) or class II (Log-rank test: χ (2) (df = 1): 0.99, p = 0.320). Adjusting for covariates, multivariate Cox models demonstrated that class II PRA >10 % was associated with a significant increase in mortality hazard (HR 1.918; 95 % CI 1.128, 3.261; p = 0.016), whereas class I PRA >10 % was uncorrelated with this outcome.
CONCLUSIONS
Pre-transplant PRA class II >10 % in adult CF patients is associated with elevated mortality hazard after LTx.
背景
成人囊性纤维化（CF）患者肺移植（LTx）前针对人类白细胞抗原的移植前抗体的生存影响尚不清楚。
方法
使用器官共享联合网络登记处（1987 - 2013年）的数据，比较移植前I类和II类群体反应性抗体（PRA）水平≤10%与>10%的成年CF患者的生存差异。
结果
在3149例CF LTx受者中，1526例和1399例分别纳入I类和II类PRA的单变量生存分析，而1106例和1001例分别纳入I类和II类的多变量Cox分析。Kaplan - Meier生存函数未能显示I类（对数秩检验：χ(2)(自由度 = 1)：1.11，p = 0.293）或II类（对数秩检验：χ(2)(自由度 = 1)：0.99，p = 0.320）PRA>10%时生存存在显著差异。在调整协变量后，多变量Cox模型显示II类PRA>10%与死亡风险显著增加相关（风险比1.918；95%置信区间1.128，3.261；p = 0.016），而I类PRA>10%与该结果无关。
结论
成年CF患者移植前II类PRA>10%与LTx后死亡风险升高相关。
Zotero 插件