Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.
Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia; Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland.
J Heart Lung Transplant. 2022 Jul;41(7):855-858. doi: 10.1016/j.healun.2021.12.006. Epub 2021 Dec 23.
Black patients suffer higher rates of antibody-mediated rejection and have worse long-term graft survival after heart transplantation. Donor-derived cell free DNA (ddcfDNA) is released into the blood following allograft injury. This study analyzed %ddcfDNA in 63 heart transplant recipients categorized by Black and non-Black race, during the first 200 days after transplant. Immediately after transplant, %ddcfDNA was higher for Black patients (mean [SE]: 8.3% [1.3%] vs 3.2% [1.2%], p = 0.001). In the first week post-transplant, the rate of decay in %ddcfDNA was similar (0.7% [0.68] vs 0.7% [0.11], p = 0.78), and values declined in both groups to a comparable plateau at 7 days post-transplant (0.46% [0.03] vs 0.45% [0.04], p = 0.78). The proportion of Black patients experiencing AMR was higher than non-Black patients (21% vs 9% [hazard ratio of 2.61 [95% confidence interval: 0.651-10.43], p = 0.18). Black patients were more likely to receive a race mismatched organ than non-Black patients (69% vs 35%, p = 0.01), which may explain the higher levels of early allograft injury.
黑人患者在心脏移植后发生抗体介导排斥反应的比率更高，且移植物长期存活率更差。供体无细胞游离 DNA（ddcfDNA）在外来组织损伤后会释放到血液中。本研究分析了 63 名心脏移植受者在移植后 200 天内的种族（黑人与非黑人）与 %ddcfDNA 的关系。移植后即刻，黑人患者的 %ddcfDNA 更高（平均值 [标准差]：8.3%[1.3%] vs 3.2%[1.2%]，p=0.001）。移植后第一周，两组患者的 %ddcfDNA 下降速率相似（0.7%[0.68] vs 0.7%[0.11]，p=0.78），且两组患者的数值均在第 7 天下降到类似的平台期（0.46%[0.03] vs 0.45%[0.04]，p=0.78）。发生 AMR 的黑人患者比例高于非黑人患者（21% vs 9%[风险比 2.61[95%置信区间：0.651-10.43]，p=0.18）。黑人患者比非黑人患者更有可能接受配型不合的器官（69% vs 35%，p=0.01），这可能解释了早期移植物损伤水平更高的原因。
