Itoda Yoshifumi, Okamoto Toshihiro, Niikawa Hiromichi, Ayyat Kamal S, Tu Chao, McCurry Kenneth R
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
Eur J Cardiothorac Surg. 2021 Jan 4;59(1):217-225. doi: 10.1093/ejcts/ezaa270.
Survival is poor following an orthotopic heart transplant with gender-mismatched donors and recipients. Patients bridged to an orthotopic heart transplant with a ventricular assist device (VAD) frequently become sensitized. We hypothesized that the combination of VAD bridging and gender-mismatch may result in greater rejection and poorer survival.
Data were obtained from the United Network of Organ Sharing database. Patients were divided into 4 groups: (i) VAD recipients who received a heart from a gender-matched donor (VAD-M); (ii) VAD recipients who received a heart from a gender-mismatched donor (VAD-MM); (iii) noVAD recipients who received a heart from a gender-matched donor (noVAD-M); and (iv) noVAD recipients who received a heart from a gender-mismatched donor (noVAD-MM). Rejection episodes within 1-year post-transplant and transplant survival were compared in VAD-M versus VAD-MM and noVAD-M versus noVAD-MM groups, respectively.
Between January 2000 and June 2017, of 33 401 adult patients who underwent heart transplants, 8648, 2441, 12 761 and 4992 patients were identified as VAD-M, VAD-MM, noVAD-M and noVAD-MM, respectively. Rejection within 1-year post-transplant occurred in 23.3% and 27.3% of the VAD-M and VAD-MM groups, respectively (P < 0.01) and in 21.8% and 23.6% of the noVAD-M and noVAD-MM groups (P = 0.02), respectively. In an adjusted survival analysis, the VAD-MM group showed significantly worse survival than the VAD-M group (P < 0.01), whereas there was no significant difference between the noVAD-M and noVAD-MM groups (P = 0.21).
Our results indicated that the combination of VAD bridging and gender-mismatch caused greater rejection and worse survival following a transplant. Further study is necessary to prove comparable post-transplant survival of gender-matched or -mismatched recipients without VAD bridging.
接受性别不匹配供体和受体原位心脏移植后的生存率较低。通过心室辅助装置（VAD）过渡到原位心脏移植的患者经常会致敏。我们推测，VAD过渡和性别不匹配相结合可能会导致更严重的排斥反应和更低的生存率。
数据来自器官共享联合网络数据库。患者分为4组：（i）接受性别匹配供体心脏的VAD受体（VAD-M）；（ii）接受性别不匹配供体心脏的VAD受体（VAD-MM）；（iii）接受性别匹配供体心脏的非VAD受体（noVAD-M）；（iv）接受性别不匹配供体心脏的非VAD受体（noVAD-MM）。分别比较VAD-M与VAD-MM组以及noVAD-M与noVAD-MM组移植后1年内的排斥反应发作情况和移植生存率。
在2000年1月至2017年6月期间，在33401例接受心脏移植的成年患者中，分别有8648、2441、12761和4992例患者被确定为VAD-M、VAD-MM、noVAD-M和noVAD-MM。移植后1年内，VAD-M组和VAD-MM组的排斥反应发生率分别为23.3%和27.3%（P<0.01），noVAD-M组和noVAD-MM组分别为21.8%和23.6%（P=0.02）。在调整后的生存分析中，VAD-MM组的生存率显著低于VAD-M组（P<0.01），而noVAD-M组和noVAD-MM组之间无显著差异（P=0.21）。
我们的结果表明，VAD过渡和性别不匹配相结合会导致移植后更严重的排斥反应和更低的生存率。有必要进一步研究以证实无VAD过渡的性别匹配或不匹配受体移植后的生存率相当。
