早期使用阿司匹林与心脏移植后移植物排斥反应和心脏移植后移植心脏血管病的关系
Early aspirin use, allograft rejection, and cardiac allograft vasculopathy in heart transplantation.
机构信息
Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, MA, USA.
Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
Clin Transplant. 2021 Oct;35(10):e14424. doi: 10.1111/ctr.14424. Epub 2021 Jul 19.
BACKGROUND
Early aspirin (ASA) use after orthotopic heart transplantation (OHT) has been associated with lower rates of cardiac allograft vasculopathy (CAV). We hypothesized that the inverse association between ASA use and CAV incidence may be most pronounced in patients with allograft rejection.
METHODS
Patients receiving OHT at a single center 2004-2010 (n = 120) were categorized by early ASA use post-transplant (ASA use for > 6 months in the first year) and the presence of biopsy-defined acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR) during 5-year follow-up. Propensity scores for ASA treatment were estimated using boosting models and applied by inverse probability of treatment weighting. The association between ASA use and time to moderate/severe CAV (ISHLT ≥ 2) was investigated.
RESULTS
Among patients with ACR or AMR, ASA therapy was associated with significantly lower rates of CAV≥ 2 (3.3 vs. 30.1%; P = .001; HR .07; 95% CI .01-.52), whereas ASA therapy was not associated with lower rates of CAV in patients with no rejection (5.6 vs. 5.3%; P = .90; HR 1.26; 95% CI .08-20.30; p = .09).
CONCLUSIONS
Early ASA use after OHT was associated with lower rates of moderate to severe CAV only in those patients with episodes of allograft rejection.
背景
心脏移植（OHT）后早期使用阿司匹林（ASA）与降低心脏移植物血管病（CAV）的发生率有关。我们假设，ASA 使用与 CAV 发生率之间的反比关系在移植后排斥反应的患者中可能最为明显。
方法
2004 年至 2010 年在一个中心接受 OHT 的患者根据移植后早期 ASA 使用情况（第一年中使用超过 6 个月）和 5 年随访期间活检定义的急性细胞排斥（ACR）和/或抗体介导的排斥（AMR）进行分类。使用提升模型估计 ASA 治疗的倾向评分，并通过治疗反概率加权进行应用。研究了 ASA 使用与中度/重度 CAV（ISHLT ≥ 2）时间的关系。
结果
在有 ACR 或 AMR 的患者中，ASA 治疗与 CAV≥2 的发生率显著降低相关（3.3%与 30.1%；P=0.001；HR 0.07；95%CI 0.01-0.52），而在无排斥反应的患者中，ASA 治疗与 CAV 发生率降低无关（5.6%与 5.3%；P=0.90；HR 1.26；95%CI 0.08-20.30；P=0.09）。
结论
OHT 后早期使用 ASA 仅与那些有移植物排斥反应的患者中度至重度 CAV 的发生率降低有关。
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