Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California; Department of Cardiovascular Medicine, Hokkaido University, Sapporo, Japan.
Cardiothoracic Surgery, Cedars-Sinai Smidt Heart Institute, Los Angeles, California.
J Heart Lung Transplant. 2019 Sep;38(9):956-962. doi: 10.1016/j.healun.2019.06.012. Epub 2019 Jun 19.
Because cardiac and renal disease are physiologically related and often coexist, the prevalence of combined heart and kidney transplantation (HKTx) has significantly increased over the last few years. It has been suggested that combined organ allografts modulate the immune system favorably for one or both allografts resulting in successful clinical outcomes. However, whether the addition of kidney transplantation has a protective immune effect against developing cardiac allograft vasculopathy (CAV) has not been fully investigated.
From March 2010 to September 2018, 30 HKTx recipients who had baseline (4-6 weeks) and 1-year intravascular ultrasound (IVUS) were matched with 60 isolated heart transplant (HTx-alone) recipients using propensity scores. First-year changes in maximal intimal thickness (MIT), maximal intimal area (MIA), maximal percent stenosis (MPS), percent atheroma volume (PAV), and incidence of rapid plaque progression were compared between the groups.
First-year coronary plaque progression was significantly decreased in HKTx recipients compared with HTx-alone recipients by change in the MIT (0.11 ± 0.14 mm vs 0.40 ± 0.32 mm, p < 0.001), MIA (0.52 ± 1.52 mm vs 1.86 ± 2.68 mm, p = 0.002), MPS (2.10% ± 5.64 percentage points vs 7.22% ± 8.59 percentage points, p = 0.001), and PAV (1.62% ± 3.07 percentage points vs 5.90% ± 5.92 percentage points, p < 0.001). Rapid plaque progression occurred in 2 of 30 in HKTx (6.7%) and in 22 of 60 HTx alone (36.7%), p = 0.002.
Combined heart and kidney transplantation is associated with a decrease in CAV by coronary plaque progression on IVUS. These results suggest that HKTx may have an immune modulating benefit over HTx alone.
由于心脏和肾脏疾病在生理上相关且常常并存，近年来，心脏和肾脏联合移植（HKTx）的患病率显著增加。有研究表明，联合器官移植物对一个或两个移植物的免疫系统具有有利的调节作用，从而获得成功的临床结果。然而，肾移植的加入是否对心脏移植后发生的冠状动脉血管病（CAV）具有免疫保护作用尚未得到充分研究。
从 2010 年 3 月至 2018 年 9 月，对 30 例接受 HKTx 的患者进行了基线（4-6 周）和 1 年血管内超声（IVUS）检查，并使用倾向评分与 60 例接受单纯心脏移植（HTx-alone）的患者进行了匹配。比较两组患者的最大内膜厚度（MIT）、最大内膜面积（MIA）、最大狭窄百分比（MPS）、动脉粥样斑块体积百分比（PAV）和快速斑块进展的发生率。
与 HTx-alone 组相比，HKTx 组患者的冠状动脉斑块在 1 年内的进展明显减少，表现为 MIT（0.11±0.14mm 比 0.40±0.32mm，p<0.001）、MIA（0.52±1.52mm 比 1.86±2.68mm，p=0.002）、MPS（2.10%±5.64 个百分点比 7.22%±8.59 个百分点，p=0.001）和 PAV（1.62%±3.07 个百分点比 5.90%±5.92 个百分点，p<0.001）的变化值均降低。HKTx 组中有 2 例（6.7%）和 HTx-alone 组中有 22 例（36.7%）发生快速斑块进展，p=0.002。
HKTx 与 IVUS 上冠状动脉斑块进展引起的 CAV 减少有关。这些结果表明，与单纯 HTx 相比，HKTx 可能具有免疫调节益处。
