Division of Infectious Diseases and Global Public Health, University of California, San Diego, California.
La Jolla Institute for Immunology, La Jolla, California.
Clin Transplant. 2018 Dec;32(12):e13439. doi: 10.1111/ctr.13439. Epub 2018 Nov 22.
Rheumatic heart disease (RHD), an autoimmune sequela of Group A streptococcal infection, is a chronic valvular disease affecting 32 million people worldwide, predominantly in developing nations. As the predisposition to autoimmune sequela still remains post transplantation, our primary objective was to assess if there were differences in mortality and rejection rates.
Using the International Society for Heart and Lung Transplantation (ISHLT) adult heart transplant registry, we identified 42 RHD patients who had undergone heart transplantation between 1988 and 2014. We matched the 42 RHD recipients by transplant year, age, and gender to 420 dilated cardiomyopathy (DCM) recipients. One-year mortality in the RHD group was 17.95% vs. 7.92% in the DCM group (P = 0.07). Survival was significantly reduced in the RHD group vs. the DCM group via Kaplan Meier curves (P = 0.04). In a multivariate model, RHD status (OR 3.19, 95% CI 1.15-8.83, P = 0.025) and serum creatinine (OR 1.41, 95% CI 1.09-1.82, P = 0.009) were associated with an increased odds of one-year mortality (P = 0.0013).
At one year post transplantation, RHD recipients had a significantly lower survival than DCM recipients. RHD status was also an independent predictor of mortality at 1 year post transplantation.
风湿性心脏病（RHD）是 A 组链球菌感染的自身免疫后遗症，是一种影响全球 3200 万人的慢性瓣膜病，主要发生在发展中国家。由于自身免疫后遗症的倾向在移植后仍然存在，我们的主要目标是评估死亡率和排斥率是否存在差异。
我们使用国际心肺移植协会（ISHLT）成人心脏移植登记处，确定了 1988 年至 2014 年间接受心脏移植的 42 例 RHD 患者。我们按移植年份、年龄和性别与 420 例扩张型心肌病（DCM）患者进行了匹配。RHD 组的 1 年死亡率为 17.95%，DCM 组为 7.92%（P=0.07）。通过 Kaplan-Meier 曲线，RHD 组的生存率明显低于 DCM 组（P=0.04）。在多变量模型中，RHD 状态（OR 3.19，95%CI 1.15-8.83，P=0.025）和血清肌酐（OR 1.41，95%CI 1.09-1.82，P=0.009）与 1 年死亡率增加相关（P=0.0013）。
移植后 1 年，RHD 受者的生存率明显低于 DCM 受者。RHD 状态也是移植后 1 年死亡率的独立预测因素。
