Alshawabkeh Laith, Herrick Nicole L, Opotowsky Alexander R, Singh Tajinder P, Landzberg Michael, Urey Marcus A, Cherikh Wida, Rossano Joseph W, Givertz Michael M
From the Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California San Diego, United States.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, United States.
Int J Cardiol Congenit Heart Dis. 2022 Apr 25;8:100384. doi: 10.1016/j.ijcchd.2022.100384. eCollection 2022 Jun.
The number of heart transplants in adults with congenital heart disease (CHD) is increasing, though outcomes remain unfavorable compared to those without CHD. The etiology of this mortality difference remains uncertain. Panel reactive antibody (PRA) is a predictor of survival post-transplantation, and adult CHD patients have been observed to have higher PRA levels. Here we assessed the relationship between PRA and outcomes in adult patients with CHD who underwent heart transplantation.
This is a retrospective cohort study using the 2004-2015 ISHLT Thoracic Organ Transplant Registry to investigate the role of sensitization in the observed excess mortality. The composite outcome of mortality or graft failure within 1-year of transplantation was compared among CHD vs. non-CHD recipients, according to sensitization as measured by pre-transplant panel reactive antibodies (PRA).
Adults with CHD (n = 1188) had higher PRA level compared to non-CHD (n = 38,201) recipients (27% vs. 18% PRA>10%, respectively, p < 0.001). CHD diagnosis remained independently associated with a higher incidence of the composite outcome in multivariable analysis after adjusting for PRA and other variables. Further, even after age-matching, patients with CHD and PRA ≤10% were at higher risk of the primary outcome compared to non-CHD (OR 2.1 [1.4-3.4], p = 0.001), though both groups had comparable outcomes when PRA was >10% (OR 1.1 [0.6-2.0], p = 0.852).
Adults with CHD are more likely to have higher sensitization and worse outcomes than non-CHD recipients. Higher sensitization rates alone do not fully explain their excess risk of adverse outcomes after heart transplantation.
先天性心脏病（CHD）成人患者心脏移植的数量在不断增加，尽管与非先天性心脏病患者相比，其预后仍然不佳。这种死亡率差异的病因尚不确定。群体反应性抗体（PRA）是移植后生存的一个预测指标，并且观察到成人先天性心脏病患者的PRA水平较高。在此，我们评估了接受心脏移植的成人先天性心脏病患者中PRA与预后之间的关系。
这是一项回顾性队列研究，使用2004 - 2015年国际心脏和肺移植学会（ISHLT）胸器官移植登记处的数据，以研究致敏作用在观察到的额外死亡率中的作用。根据移植前群体反应性抗体（PRA）测量的致敏情况，比较先天性心脏病与非先天性心脏病受者在移植后1年内死亡或移植物失败的复合结局。
与非先天性心脏病受者（n = 38,201）相比，先天性心脏病成人患者（n = 1188）的PRA水平更高（分别为27%对18%的PRA>10%，p < 0.001）。在对PRA和其他变量进行调整后的多变量分析中，先天性心脏病诊断仍然与复合结局的较高发生率独立相关。此外，即使在年龄匹配后，PRA≤10%的先天性心脏病患者与非先天性心脏病患者相比，主要结局的风险更高（OR 2.1 [1.4 - 3.4]，p = 0.001），尽管当PRA>10%时两组的结局相当（OR 1.1 [0.6 - 2.0]，p = 0.852）。
与非先天性心脏病受者相比，先天性心脏病成人患者更有可能具有更高的致敏性和更差的结局。单独较高的致敏率并不能完全解释他们心脏移植后不良结局的额外风险。
