Katona Hajna, Soltesz Adam, Kovacs Eniko, Szakal-Toth Zsofia, Tamaska Eszter, Racz Kristof, Radovits Tamás, Fintha Attila, Kovács Krisztián, Hurler Lisa, Prohászka Zoltán, Merkely Bela, Nemeth Endre
Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
University Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
Front Med (Lausanne). 2025 Aug 13;12:1541519. doi: 10.3389/fmed.2025.1541519. eCollection 2025.
The aim of this study was to investigate the modulatory effect of intraoperative hemoadsorption (HA) versus standard care on the perioperative inflammatory profile of patients undergoing orthotopic heart transplantation (OHT) and its correlation with the severity of post-transplant vasoregulatory dysfunction.
In this secondary analysis, data from NCT03145441, a prospective, single-center, open-label, randomized controlled trial were used.
Patients in the HA group had a lower median vasopressor score, rate of severe vasoregulatory dysfunction (vasopressor score: 19.7 [7.9-37.8] vs. 35.6 [14.5-57.6], = 0.031, respectively and severe vasoregulatory dysfunction: 33.3% vs. 60.0% = 0.048, respectively), and reduced procalcitonin (PCT) level (PCT: 0.93 [0.38-2.36] μg/L vs. 2.08 [1.13-6.36] μg/L, = 0.007, respectively) during the early postoperative period than patients in the control group. The 24-h cytokine and complement levels were comparable in the study groups. The 24-h inflammatory profile of HA and control groups remained unchanged in the cluster of severe vasoregulatory dysfunction. There was a moderate positive correlation between the vasopressor score and the PCT concentration in the control group ( : 0.605, = 0.002) which was not identified in the HA group.
Intraoperative HA treatment exerts a beneficial modulatory effect on the postoperative PCT response in OHT recipients, which is directly associated with significantly lower rates of post-transplant severe vasoregulatory dysfunction compared to controls.
本研究旨在探讨术中血液吸附（HA）与标准治疗对原位心脏移植（OHT）患者围手术期炎症指标的调节作用及其与移植后血管调节功能障碍严重程度的相关性。
在这项二次分析中，使用了来自NCT03145441的前瞻性、单中心、开放标签、随机对照试验的数据。
与对照组相比，HA组患者术后早期的血管升压药评分中位数、严重血管调节功能障碍发生率（血管升压药评分：分别为19.7[7.9 - 37.8]和35.6[14.5 - 57.6]，P = 0.031；严重血管调节功能障碍：分别为33.3%和60.0%，P = 0.048）以及降钙素原（PCT）水平降低（PCT：分别为0.93[0.38 - 2.36]μg/L和2.08[1.13 - 6.36]μg/L，P = 0.007）。研究组之间24小时细胞因子和补体水平相当。在严重血管调节功能障碍组中，HA组和对照组的24小时炎症指标保持不变。对照组中血管升压药评分与PCT浓度之间存在中度正相关（r = 0.605，P = 0.002），而HA组未发现这种相关性。
术中HA治疗对OHT受者术后PCT反应具有有益的调节作用，与对照组相比，这与移植后严重血管调节功能障碍的发生率显著降低直接相关。
