Bahatyrevich Nataliya, Dale Reid, Leipzig Matthew, Pines Katharine Casselman, Jimenez Shirin, Currie Maria
Department of Surgery, University of California, Davis, Sacramento, California.
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
JHLT Open. 2025 Mar 31;8:100246. doi: 10.1016/j.jhlto.2025.100246. eCollection 2025 May.
There is no consensus regarding induction therapy in patients on mechanically circulatory support (MCS) listed for heart transplantation. We sought to elucidate differences in outcomes between no induction and induction.
A total of 3,987 patients were analyzed from the UNOS database from January 2018 through December 2022. Patients on Extracorporeal Membrane Oxygenation (ECMO), HeartMate 3, Impella 5.0 or 5.5, and intra-aortic balloon pump (IABP) and receiving no induction, anti-IL2R antibodies, or T cell depleting agent (TCDA) were included.
Of 3,987 patients, 1,288 (32.3%) received no induction, 1,566 (39.3%) received anti-IL2R antibodies, and 1,133 (28.4%) received TCDA. A total of 1,895 (47.5%) were supported with IABP; 1,098 (27.5%) with HeartMate 3; 489 (12.3%) with Impella 5.0 or 5.5; 351 (8.8%) with ECMO; and 154 (3.9%) with combination of the above devices. Comparison of 1-year survival between no induction, anti-IL2R, and TCDA groups in all MCS patients revealed significantly worse survival among those receiving no induction (p<0.0001). Subgroup analysis of peak CPRA 0% patients revealed that no induction had significantly worse survival at 1 year (p=0.002). Analysis of acute rejection at 1 year showed a significantly decreased number of rejection episodes in the TCDA group compared to no induction (OR 0.65, CI 0.47-0.88, p=0.006).
Patients requiring MCS prior to heart transplantation have significantly improved post-transplant survival with induction therapy, regardless of their peak CPRA. TCDA confers decreased number of acute rejection episodes at 1 year in this patient population.
对于列入心脏移植名单且接受机械循环支持（MCS）的患者，诱导治疗尚无共识。我们试图阐明不进行诱导治疗与进行诱导治疗在结局上的差异。
对2018年1月至2022年12月期间来自器官共享联合网络（UNOS）数据库的3987例患者进行分析。纳入接受体外膜肺氧合（ECMO）、HeartMate 3、Impella 5.0或5.5以及主动脉内球囊反搏（IABP）且未接受诱导治疗、抗白细胞介素2受体（IL2R）抗体或T细胞清除剂（TCDA）的患者。
在3987例患者中，1288例（32.3%）未接受诱导治疗，1566例（39.3%）接受抗IL2R抗体治疗，1133例（28.4%）接受TCDA治疗。共有1895例（47.5%）接受IABP支持；1098例（27.5%）接受HeartMate 3支持；489例（12.3%）接受Impella 5.0或5.5支持；351例（8.8%）接受ECMO支持；154例（3.9%）接受上述装置联合支持。对所有MCS患者中未接受诱导治疗、抗IL2R和TCDA组的1年生存率进行比较，结果显示未接受诱导治疗的患者生存率显著更差（p<0.0001）。对峰值群体反应性抗体（CPRA）为0%的患者进行亚组分析显示，未接受诱导治疗的患者1年生存率显著更差（p=0.002）。对1年时急性排斥反应的分析显示，与未接受诱导治疗相比，TCDA组的排斥反应发作次数显著减少（比值比0.65，可信区间0.47 - 0.88，p=0.006）。
心脏移植前需要MCS的患者，无论其峰值CPRA如何，诱导治疗均能显著提高移植后的生存率。在该患者群体中，TCDA可使1年时急性排斥反应发作次数减少。
