Medical Clinic III - Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany; Medical Clinic I - Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany.
Medical Clinic III - Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany; Medical Clinic II - Nephrology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany; Medical Clinic III - Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Biomol Biomed. 2023 Feb 1;23(1):145-152. doi: 10.17305/bjbms.2022.7720.
Surgical aortic valve replacement (SAVR) in kidney transplant recipients (KTR) is associated with high morbidity and mortality, and an increased risk of postoperative graft failure potentially leading to graft loss. Transcatheter aortic valve implantation (TAVI) emerged as an alternative in high-risk patients. However, data on TAVI in kidney transplant recipients are limited. We performed a retrospective analysis of 40 KTR in which aortic valve replacement was performed at our center between 2005 and 2015. The outcomes and follow-up of TAVI (n=20; 2010-2015) and SAVR (n=20; 2005-2015) were analyzed with respect to patient and graft survival. Baseline characteristics in both groups were comparable. Hospital stay after TAVI was significantly shorter compared to SAVR (19 [11.5-21.75] days vs. 33 [21-62] days, p=0.001). Acute graft failure occurred more frequently after SAVR (45% vs. 89.5%; p=0.006). Thirty-day mortality was 10% in both groups. However, in-hospital mortality reached 25% in the SAVR group (TAVI 10%), indicating a more complicated course after surgery. Moreover, during a median follow-up time of 1928 days in TAVI patients and 2717 days in patients after SAVR, graft loss occurred only in the surgically treated group (n=7). While one-year survival after TAVR was 90% compared to 69% after SAVR, long-term follow-up showed comparable results (at 5 years: TAVI 58% vs. 52% SAVR; log-rank-test: p=0.86). In KTR, TAVI can be performed with good mid- to long-term results. Compared to SAVR, renal outcomes seem to be improved after TAVI, suggesting better graft survival.
在肾移植受者（KTR）中，外科主动脉瓣置换术（SAVR）与高发病率和死亡率相关，并且术后移植物衰竭的风险增加，可能导致移植物丢失。经导管主动脉瓣植入术（TAVI）作为高危患者的替代方法出现。然而，关于 TAVI 在肾移植受者中的数据有限。我们对 2005 年至 2015 年期间在我们中心接受主动脉瓣置换术的 40 名 KTR 进行了回顾性分析。分析了 TAVI（n=20；2010-2015 年）和 SAVR（n=20；2005-2015 年）的患者和移植物存活率，并比较了两组的结果和随访情况。两组患者的基线特征相当。TAVI 后的住院时间明显短于 SAVR（19 [11.5-21.75] 天 vs. 33 [21-62] 天，p=0.001）。SAVR 后急性移植物衰竭更为常见（45% vs. 89.5%；p=0.006）。两组 30 天死亡率均为 10%。然而，SAVR 组的院内死亡率为 25%（TAVI 为 10%），表明手术后的病情更为复杂。此外，在 TAVI 患者的中位随访时间为 1928 天和 SAVR 患者的 2717 天中，仅在手术治疗组中发生移植物丢失（n=7）。TAVR 后一年的存活率为 90%，而 SAVR 后为 69%，但长期随访结果相似（5 年时：TAVI 为 58%，SAVR 为 52%；对数秩检验：p=0.86）。在 KTR 中，TAVI 可以获得良好的中期至长期结果。与 SAVR 相比，TAVI 后肾脏结局似乎得到改善，提示移植物存活率更高。
