心脏移植术后移植物血管病:阜外医院单中心长期随访结果总结

Cardiac allograft vasculopathy after heart transplantation:summary of a single-center long-term follow-up experience in Fuwai Hospital

目的总结心脏移植术后心脏移植物血管病变(CAV)的发生情况及其对患者长期存活的影响。方法回顾性分析1006例心脏移植受者的临床资料,48例CAV患者中4例因缺失影像学证据未纳入分析。1002例受者中,根据CAV发生情况分为CAV组(44例)和无CAV组(958例)。总结CAV的发生情况,比较两组患者的临床资料,分析CAV患者的影像学诊断方式及冠状动脉病变情况、药物治疗及合并症情况、术后生存情况及死亡原因。结果1006例心脏移植受者中共48例发生CAV,发生率为4.77%。与无CAV组比较,CAV组患者术前吸烟史、术前高血压病史、原发病为冠状动脉疾病及围手术期感染的比例均较高(均为P<0.05)。44例通过影像学诊断CAV的患者中,24例通过冠状动脉CT血管造影(CTA)诊断CAV,4例通过冠状动脉造影(CAG)诊断CAV,16例联合使用冠状动脉CTA及CAG诊断CAV。44例患者中,CAV 1级占45%(20/44),CAV 2级占30%(13/44),CAV 3级占25%(11/44)。全部患者术后长期使用他汀类药物治疗,有20例患者应用抗血小板药物治疗。44例CAV患者中,11例患者接受经皮冠状动脉介入治疗,6例患者接受再次心脏移植,共8例患者死亡。Kaplan-Meier生存分析结果显示,CAV组和无CAV组患者术后长期生存率差异无统计学意义(P>0.05),但在诊断CAV后(术后6~7年),患者的生存率呈下降的趋势;CAV 1级、CAV 2级和CAV 3级患者术后长期生存率差异无统计学意义(P>0.05),但即使是病变较轻的CAV 1级患者,术后远期生存率也呈下降趋势。结论CAV是心脏移植术后常见且棘手的并发症,诊断CAV后患者长期生存率呈下降趋势。应提高对CAV的认识,早预防、早诊断、早治疗,以提高患者心脏移植术后的长期生存率。

Objective To summarize the incidence of cardiac allograft vasculopathy(CAV)after heart transplantation and the effect on the long-term survival of recipients.Methods Clinical data of 1006 heart transplant recipients were retrospectively analyzed.Of 48 CAV patients,4 cases were not included in this analysis due to lack of imaging evidence.A total of 1002 recipients were divided into the CAV group(n=44)and non-CAV group(n=958)according to the incidence of CAV.The incidence of CAV was summarized.Clinical data of all patients were statistically compared between two groups.Imaging diagnosis,coronary artery disease,drug treatment and complications,postoperative survival and causes of death of CAV patients were analyzed.Results Among 1006 heart transplant recipients,48 cases(4.77%)developed CAV.Compared with the non-CAV group,the proportion of preoperative smoking history,preoperative hypertension history,coronary artery disease and perioperative infection was significantly higher in the CAV group(all P<0.05).Among 44 patients diagnosed with CAV by imaging examination,24 cases were diagnosed with CAV by coronary CT angiography(CTA),4 cases by coronary angiography(CAG),and 16 cases by coronary CTA combined with CAG.Among 44 patients,the proportion of gradeⅠCAV was 45%(20/44),30%(13/44)for gradeⅡCAV and 25%(11/44)for gradeⅢCAV,respectively.All patients received long-term use of statins after operation,and 20 patients were given with antiplatelet drugs.Among 44 CAV patients,11 patients underwent percutaneous coronary intervention,6 cases received repeated heart transplantation,and 8 patients died.Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups(P>0.05),whereas the survival rate of patients tended to decline after the diagnosis of CAV(at postoperative 6-7 years).The long-term survival rates of patients with gradeⅠ,gradeⅡand gradeⅢCAV showed no significant difference(P>0.05).Even for patients with gradeⅠCAV,the long-term survival rate tended to decline.Conclusions CAV is a common and intractable complication following heart transplantation,and the long-term survival rate of patients after the diagnosis of CAV tended to decline.Deepening understanding of CAV,prompt prevention,diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.