Comparison of cardiac allograft vasculopathy in heart and heart-lung transplantations: A 15-year retrospective study

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• 作者：Julien Guihaire ; MD^a ; ^{julien.guihaire@u-psud.fr" class="auth_mail} ; Olaf Mercier ; MD ; PhD^b ; Erwan Flé ; cher ; MD ; PhD^a ; Marie Aymami ; MD^a ; Soly Fattal ; MD^b ; Cé ; line Chabanne ; MD^a ; Francois Leroy Ladurie ; MD^b ; Bernard Lelong ; MD^a ; Jacques Cerrina ; MD^b ; Thierry Langanay ; MD^a ; Sacha Mussot ; MD^b ; Dominique Fabre ; MD^b ; Bertrand De Latour ; MD^a ; Hervé ; Corbineau ; MD^a ; Jean-Philippe Verhoye ; MD ; PhD^a ; Philippe Dartevelle ; MD^b ; Alain Leguerrier ; MD^a ; Elie Fadel ; MD ; PhD^b
• 关键词：cardiac allograft vasculopathy ; heart&ndash ; lung transplantation ; immune tolerance ; long-term outcomes
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：June 2014
• 年：2014
• 卷：33
• 期：6
• 页码：636-643
• 全文大小：423 K

文摘

Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HTx). Specific determinants of CAV and long-term outcome after CAV occurrence have been poorly investigated after heart–lung transplantation (HLTx).

Methods

Between January 1996 and December 2006, 79 patients underwent HLTx (36.3 ± 12.2 years old; 47% men) and 141 patients underwent HTx (49.2 ± 12.3 years old; 77% men) at two different institutions. CAV grading was reviewed in both groups according to the 2010 standardized nomenclature of the International Society for Heart and Lung Transplantation. The mean post-transplant follow-up was 94 (1 to 181) months.

Results

Overall 10-year survival rate was 58% after HTx and 43% after HLTx (p = 0.11). The Grade 1 (or higher) CAV-free survival rate was 95% at 4 years and 69% at 10 years after HLTx, and 77% and 39%, respectively, after HTx (p < 0.01). Mean cyclosporine blood levels were similar between the groups at 3, 6, 12, 24 and 36 months. The main causes of mortality beyond 5 years after HTx and HLTx were malignancies and bronchiolitis obliterans, respectively. By multivariate analysis, recipients who developed >3 acute myocardial rejections during the first year post-transplant were exposed to a higher risk of CAV (95% CI 1.065 to 2.33, p = 0.02). Episodes of acute pulmonary rejection and bronchiolitis obliterans were not associated with an increased risk of CAV (p = 0.52 and p = 0.30).

Conclusion

HLTx recipients appeared protected from CAV compared with HTx patients in this retrospective study. Repeated acute cardiac rejections were independent predictors of CAV. Unlike bronchiolitis obliterans, CAV had a very low impact on long-term survival after HLTx.