Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
J Heart Lung Transplant. 2017 Jul;36(7):787-796. doi: 10.1016/j.healun.2017.02.015. Epub 2017 Feb 17.
Sensitized heart transplant candidates spend more time and have higher mortality on the waiting list. Although the calculated panel-reactive antibody (CPRA) value is used to assign allocation priority to kidney transplant candidates in the United States, the relationship between CPRA and outcomes on the heart transplant waiting list is unknown.
A data set of patients listed for heart transplant with unacceptable human leukocyte antigens (HLA) entered was obtained from the United Network for Organ Sharing. The study cohort was composed of 3,855 adult candidates listed for heart transplant between 2006 and 2013 with active waiting time. The cohort was divided into 5 groups by increasing CPRA. Outcomes were assessed using competing risks and sub-hazard regression analyses.
In each group of successively higher CPRA, the percentage of candidates who received a transplant decreased, whereas the percentage of those who were still waiting for a transplant increased, as did the percentage of those removed from the waiting list or had died. The group of candidates with a CPRA >80% displayed a markedly decreased incidence of transplantation (hazard ratio 0.37) and an increased risk of removal from the waiting list or death (hazard ratio 2.18) as compared to those with CPRA of ≤10%.
Sensitized heart transplant candidates are at high risk of adverse outcomes on the heart transplant waiting list. Clinicians should strive to minimize the CPRA by maximizing specificity in the selection of HLA antigens to exclude. The optimal clinical approach for candidates with high CPRA requires further study.
致敏的心脏移植候选者在等待名单上花费的时间更长，死亡率更高。尽管在美国，计算出的群体反应性抗体 (CPRA) 值用于为肾移植候选者分配分配优先级，但 CPRA 与心脏移植等待名单上的结果之间的关系尚不清楚。
从器官共享联合网络获得了一份不可接受的人类白细胞抗原 (HLA) 列于心脏移植名单的数据。研究队列由 2006 年至 2013 年期间活跃等待时间的 3855 名成年心脏移植候选者组成。该队列根据 CPRA 递增分为 5 组。使用竞争风险和亚危险回归分析评估结果。
在 CPRA 逐渐升高的每组中，接受移植的候选者百分比下降，而仍在等待移植的候选者百分比增加，从等待名单中除名或死亡的候选者百分比也增加。与 CPRA≤10%的候选者相比，CPRA>80%的候选者移植的发生率明显降低（危险比 0.37），并且从等待名单中除名或死亡的风险增加（危险比 2.18）。
致敏的心脏移植候选者在心脏移植等待名单上发生不良结果的风险很高。临床医生应通过最大限度地提高 HLA 抗原选择的特异性来努力降低 CPRA，以排除抗原。高 CPRA 候选者的最佳临床方法需要进一步研究。
