Mills R M, Naftel D C, Kirklin J K, Van Bakel A B, Jaski B E, Massin E K, Eisen H J, Lee F A, Fishbein D P, Bourge R C
University of Kentucky, Lexington, USA.
J Heart Lung Transplant. 1997 Aug;16(8):813-21.
The natural history of patients experiencing hemodynamic compromise with rejection has been incompletely characterized. This multiinstitutional study examined the outcome of such episodes, particularly with regard to the extent of cellular infiltrate on the index endomyocardial biopsy.
From January 1, 1990, through June 30, 1994, 3367 patients in the Cardiac Transplant Research Database experienced 4137 episodes of rejection. Severe hemodynamic compromise occurred in approximately 5% of the rejection episodes, and this proportion remained relatively constant over time.
Recipient risk factors for rejection with severe hemodynamic compromise included black race, female recipient sex, and diabetes. The 3-month actuarial survival rate was 60% after rejection with severe hemodynamic compromise versus 95% after rejection with no or mild compromise. Low initial biopsy score conferred a higher early survival, but a lower survival at 2 years after rejection with severe hemodynamic compromise. Among patients who survive an initial rejection episode with severe hemodynamic compromise, survival at 2 years after an episode was 46% among those who had a low initial biopsy score versus 84% with a high biopsy score.
Rejection with hemodynamic compromise, although rare, represents a major complication of heart transplantation with a poor long-term outcome. Survivors of hemodynamically compromising rejection episodes associated with low biopsy scores in the International Society for Heart and Lung Transplantation grading system have a significantly worse long-term outcome than survivors of episodes associated with high scores. These findings suggest that immunologic mechanisms other than lymphocytic infiltration of the cardiac allograft are important and distinct causes of allograft dysfunction.
血流动力学因排斥反应而受损的患者的自然病史尚未完全明确。这项多机构研究调查了此类事件的结果，特别是关于首次心内膜心肌活检时细胞浸润的程度。
从1990年1月1日至1994年6月30日，心脏移植研究数据库中的3367例患者经历了4137次排斥反应。约5%的排斥反应发作出现严重血流动力学受损，且这一比例随时间相对保持稳定。
出现严重血流动力学受损的排斥反应的受者风险因素包括黑人种族、女性受者性别和糖尿病。严重血流动力学受损的排斥反应后3个月的精算生存率为60%，而无或轻度受损的排斥反应后为95%。初始活检评分低者早期生存率较高，但严重血流动力学受损的排斥反应后2年生存率较低。在首次严重血流动力学受损的排斥反应发作中存活下来的患者中，初始活检评分低者发作后2年生存率为46%，而活检评分高者为84%。
血流动力学因排斥反应而受损，虽然罕见，但却是心脏移植的主要并发症，长期预后较差。在国际心肺移植学会分级系统中，活检评分低的血流动力学受损排斥反应发作的幸存者的长期预后明显比活检评分高的发作的幸存者差。这些发现表明，除了心脏同种异体移植物的淋巴细胞浸润之外，其他免疫机制也是同种异体移植物功能障碍的重要且独特的原因。
