Johnson M R, Naftel D C, Hobbs R E, Kobashigawa J A, Pitts D E, Levine T B, Tolman D, Bhat G, Kirklin J K, Bourge R C
Rush Medical College, Chicago, Illinois, USA.
J Heart Lung Transplant. 1997 Aug;16(8):801-12.
Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation.
In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males.
The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007).
Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.
关于女性在心脏移植后似乎面临更高排斥风险的原因仍存在争议。因此，本研究旨在确定围产期心肌病的移植前诊断的影响以及既往妊娠对女性心脏移植后结局（排斥发生率和死亡率）的影响。
在这项对3244名成年（大于13岁）心脏移植受者的多机构研究中，(a) 将40名因围产期心肌病接受移植的女性的结局与200名因其他适应症接受移植的育龄（13至45岁）女性的结局进行比较，以及 (b) 将543名有妊娠史的女性的移植后结局与101名未生育的成年女性和2562名成年男性的结局进行比较。
有围产期心肌病病史的女性的移植后结局与因其他适应症接受移植的育龄女性的结局相似。然而，经产妇首次排斥的时间明显短于未生育女性或男性（p < 0.0001），且累积排斥反应更多。通过多变量分析，1年时累积排斥的危险因素为妊娠史（p < 0.0001）、受者年龄较小（p < 0.0001）、诱导治疗（p < 0.0001）以及人类白细胞抗原-DR错配数（p = 0.007）。
我们的数据表明，与心脏移植后女性排斥频率增加相关的是既往妊娠，而非性别本身。
