Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Surgery, Lund University and Skane University Hospital, Lund, Sweden.
Clin Transplant. 2020 May;34(5):e13840. doi: 10.1111/ctr.13840. Epub 2020 Mar 13.
Ischemia/reperfusion may lead to graft dysfunction in heart transplantation (HT). The purpose of this study was to evaluate the influence of ischemic and reperfusion time on acute cellular rejection (ACR) within the first-year post-HT and on long-term outcomes. Data were collected from 331 patients (mean age 49 ± 12 y, 28% females) who underwent HT 1988-2016. Endomyocardial biopsies obtained within the first year after HT were graded according to the 2004-ISHLT-WF. We classified the patients by ischemic time </≥4 hours and further by reperfusion time </≥90 minutes. Primary endpoint was ACR ≥ 2R within one-year post-HT. A multiple logistic regression analysis was used to adjust for potential confounders. Secondary endpoint was long-term survival. There were 56 (17%) patients who received donor hearts with ischemic time >4 hours, and of these, 31 (55%) patients had reperfusion with CPB ≥90 minutes. Ischemia >4 hours had an increased risk of ACR ≥ 2R during the first year (adjusted OR = 3.1, P = .016); however, an extended reperfusion ≥90 minutes reduced the risk (adjusted OR = 0.25, P = .024). The conditional probability of surviving 10 years post-transplant, given that the patients already survived first year, was inferior for recipients with ischemia ≥ 4 hours and reperfusion <90 minutes, 59%, compared with the other groups 83%, P = .016. Prolonged reperfusion appears to reduce the risk for ACR ≥ 2R and improve long-term survival.
缺血/再灌注可能导致心脏移植（HT）中的移植物功能障碍。本研究的目的是评估缺血和再灌注时间对 HT 后 1 年内急性细胞排斥反应（ACR）的影响，并评估其对长期结果的影响。研究数据来自于 1988 年至 2016 年间接受 HT 的 331 名患者（平均年龄 49±12 岁，28%为女性）。HT 后 1 年内获得的心肌活检标本根据 2004-ISHLT-WF 标准进行分级。我们根据缺血时间 </≥4 小时和再灌注时间 </≥90 分钟对患者进行分类。主要终点是 HT 后 1 年内发生 ACR≥2R。采用多因素逻辑回归分析调整潜在混杂因素。次要终点是长期生存。有 56 名（17%）患者接受了缺血时间>4 小时的供心，其中 31 名（55%）患者的 CPB 再灌注时间≥90 分钟。缺血时间>4 小时与 HT 后 1 年内发生 ACR≥2R 的风险增加相关（调整后的 OR=3.1，P=.016）；然而，延长的再灌注时间≥90 分钟降低了这种风险（调整后的 OR=0.25，P=.024）。在已经存活 1 年的患者中，给定缺血时间≥4 小时且再灌注时间<90 分钟，移植后 10 年的生存条件概率为 59%，而其他组的生存条件概率为 83%，P=.016。延长再灌注时间似乎可以降低 ACR≥2R 的风险，并改善长期生存。
