背景:传统上,正交叉匹配(+XM)与小儿心脏移植后的不良结局相关。然而,最近的研究表明,尽管有+XM,但仍可能取得有利的中期结果。这项研究的假设是+XM的儿童有相似的长期生存率,但是排斥反应等并发症的发生率更高,冠状动脉移植血管病变(CAV),和感染,与(-)XM阴性的患者相比。
方法:从2010年至2021年,对所有年龄<18岁且已知XM的患者查询了小儿心脏移植协会注册(PHTS)数据库。使用适当的参数和非参数组比较,在+XM组和-XM组之间比较基线人口统计学。Cox比例危险模型用于确定移植后移植物丢失的危险因素,拒绝,和CAV。
结果:在研究期间的4599例小儿心脏移植手术中,XM结果可用于3914(85%),其中373人(9.5%)有+XM。单变量分析显示,+XM患者的10年生存率较低(HR=1.3,p=0.04)。多因素分析显示两组的10年生存率无显著差异;然而,+XM组的首次排斥时间(p=0.0001)仍然显著缩短。
结论:通过+XM移植的儿科患者经历了较早的排斥反应;然而,经过多变量调整后,+XM与中期移植物损失不独立相关。针对a+XM的心脏移植的风险必须与等待名单死亡的持续风险相平衡。
BACKGROUND: A positive crossmatch (+ XM) has traditionally been associated with adverse outcomes following pediatric heart transplantation. However, more recent studies suggest that favorable intermediate-term outcomes may be achieved despite a + XM. This study\'s hypothesis is that children with a + XM have similar long-term survival, but higher rate of complications such as rejection, coronary allograft vasculopathy (CAV), and infection, compared to patients with a negative (-) XM.
METHODS: The Pediatric Heart Transplant Society Registry (PHTS) database was queried from 2010-2021 for all patients <18 years of age with a known XM. Baseline demographics were compared between + XM and - XM groups using appropriate parametric and non-parametric group comparisons. Cox Proportional Hazards Modeling was used to identify risk factors for post-transplant graft loss, rejection, and CAV.
RESULTS: Of 4599 pediatric heart transplants during the study period, XM results were available for 3914 (85%), of which 373 (9.5%) had a + XM. Univariate analysis showed lower 10-year survival for patients with + XM (HR = 1.3, p = .04). Multivariate analyses revealed no significant difference in 10-year survival in the 2 groups; however, time to first rejection (p = .0001) remained significantly shorter in the + XM group.
CONCLUSIONS: Pediatric patients transplanted across a + XM experience earlier rejection; however, after multivariate adjustment, + XM is not independently associated with intermediate-term graft loss. The risk of heart transplantation against a + XM must be balanced with the ongoing risk of waitlist mortality.