背景:最近的研究表明,来自病毒血症供体的丙型肝炎(HCV)心脏移植与非病毒血症供体的1年生存率相当。尽管HCV病毒血症是动脉粥样硬化加速的已知危险因素,心脏移植血管病变(CAV)结局的数据有限.我们比较了来自HCV病毒血症供体(核酸扩增测试阳性;NAT)的心脏移植受者与非HCV感染供体(NAT-)的CAV发生率。
方法:我们回顾性回顾了两个大型心脏移植中心2017年4月至2020年8月的血管内超声年度冠状动脉造影。CAV根据ISHLT指南进行分级。最大内膜厚度(MIT)≥0.5mm被认为对亚临床疾病具有重要意义。
结果:在270名心脏移植受者中(平均年龄54岁;77%为男性),62例患者从NAT+供体移植。CAV≥1级存在于NAT+的8.8%与NAT-组的16.8%在1年。20%与两年时的28.8%,和33.3%,而3年为41.5%。调整供体年龄后,供者吸烟史,受者BMI,收件人,高血压,和接受者糖尿病,NAT+状态不会增加CAV(HR.80;95%CI.45-1.40,p=0.43)或亚临床IVUS疾病(HR.87;95%CI.58-1.30,p=0.49)的风险。此外,IVUS上快速进展性病变的存在没有差异.
结论:我们的数据表明,在接受HCV治疗的心脏移植患者队列中,NAT+供体在移植后没有增加早期CAV或亚临床IVUS疾病的风险,建议该策略的短期安全性,以最大限度地增加可用的供体心脏库。
Recent studies suggest the transplantation of Hepatitis C (HCV) hearts from viremic donors is associated with comparable 1 year survival to nonviremic donors. Though HCV viremia is a known risk factor for accelerated atherosclerosis, data on cardiac allograft vasculopathy (CAV) outcomes are limited. We compared the incidence of CAV in heart transplant recipients from HCV viremic donors (nucleic acid amplification test positive; NAT+) compared to non-HCV infected donors (NAT-).
We retrospectively reviewed annual coronary angiograms with intravascular ultrasound from April 2017 to August 2020 at two large cardiac transplant centers. CAV was graded according to ISHLT guidelines. Maximal intimal thickness (MIT) ≥ 0.5 mm was considered significant for subclinical disease.
Among 270 heart transplant recipients (mean age 54; 77% male), 62 patients were transplanted from NAT+ donors. CAV ≥ grade 1 was present in 8.8% of the NAT+ versus 16.8% of the NAT- group at 1 year, 20% versus 28.8% at 2 years, and 33.3% versus 41.5% at 3 years. After adjusting for donor age, donor smoking history, recipient BMI, recipient, hypertension, and recipient diabetes, NAT+ status did not confer increased risk of CAV (HR.80; 95% CI.45-1.40, p = 0.43) or subclinical IVUS disease (HR.87; 95% CI.58-1.30, p = 0.49). Additionally, there was no difference in the presence of rapidly progressive lesions on IVUS.
Our data show that NAT+ donors conferred no increased risk for early CAV or subclinical IVUS disease following transplantation in a cohort of heart transplant patients who were treated for HCV, suggesting the short-term safety of this strategy to maximize the pool of available donor hearts.