Mehra M R, Stapleton D D, Ventura H O, Escobar A, Cassidy C A, Smart F W, Collins T J, Ramee S R, White C J
Department of Internal Medicine, Ochsner Clinic, New Orleans, LA 70121.
Circulation. 1994 Nov;90(5 Pt 2):II78-82.
Cardiac allograft vasculopathy remains the leading limitation to long-term survival after cardiac transplantation. While the influence of donor and recipient gender in the pathogenesis of cardiac vasculopathy is still poorly understood, studies have indicated that female allografts may be at higher risk for the development of cardiac allograft vasculopathy. The purpose of this study was to characterize the influence of donor and recipient gender on the early genesis of cardiac allograft vasculopathy by using intravascular ultrasound.
Thirty-six consecutive cardiac transplant recipients were divided into three groups on the basis of donor and recipient gender as follows: group 1, female donor and male recipient (n = 8); group 2, male donor and female recipient (n = 7); and group 3, male donor and male recipient (n = 21). The three groups were similar with regard to donor and recipient age, weight, body surface area, serum lipids, left ventricular function, histocompatibility, cellular and vascular rejection, and cytomegalovirus infection. To precisely quantitate the extent of cardiac allograft vasculopathy, intravascular ultrasound was performed in all patients at the time of first annual angiography. Intimal thickening and intimal index were accurately quantitated by intravascular ultrasound. Intimal thickening was significantly greater in group 1 (0.55 +/- 0.15 mm) than in group 2 (0.18 +/- 0.04 mm) or group 3 (0.29 +/- 0.05 mm) (P < .05). In addition, the intimal index was greater in group 1 (0.20 +/- 0.04) than in group 2 (0.07 +/- 0.02) or group 3 (0.15 +/- 0.02) (P < .01, group 1 versus group 2).
Male recipients of female allografts have a higher degree of vascular intimal hyperplasia detected by intravascular ultrasound at 1 year after heart transplantation. These findings indicate that donor and recipient gender influences the early genesis of cardiac allograft vasculopathy.
心脏移植后，心脏移植血管病变仍然是长期存活的主要限制因素。虽然供体和受体性别对心脏血管病变发病机制的影响仍了解不足，但研究表明，女性移植物发生心脏移植血管病变的风险可能更高。本研究的目的是通过血管内超声来描述供体和受体性别对心脏移植血管病变早期发生的影响。
36例连续的心脏移植受者根据供体和受体性别分为三组，如下：第1组，女性供体和男性受体（n = 8）；第2组，男性供体和女性受体（n = 7）；第3组，男性供体和男性受体（n = 21）。三组在供体和受体年龄、体重、体表面积、血脂、左心室功能、组织相容性、细胞和血管排斥反应以及巨细胞病毒感染方面相似。为了精确量化心脏移植血管病变的程度，在首次年度血管造影时对所有患者进行血管内超声检查。通过血管内超声准确量化内膜增厚和内膜指数。第1组（0.55±0.15mm）的内膜增厚明显大于第2组（0.18±0.04mm）或第3组（0.29±0.05mm）（P < 0.05）。此外，第1组（0.20±0.04）的内膜指数大于第2组（0.07±0.02）或第3组（0.15±0.02）（P < 0.01，第1组与第2组相比）。
心脏移植术后1年，接受女性移植物的男性受者通过血管内超声检测到的血管内膜增生程度更高。这些发现表明供体和受体性别影响心脏移植血管病变的早期发生。
