接受乙型肝炎病毒（HBV）阳性供体心脏的患者的心脏移植结

StephenW

Heart Transplant Outcomes in Patients Who Receive Hepatitis B Virus (HBV) Positive Donor Hearts
P A Genyk  1 , G S Liu  1 , J Nattiv  1 , P Banankhah  1 , J P Li  1 , P A Kingsford  1 , A Wolfson  2 , D Vucicevic  3 , A S Vaidya  1 , E C DePasquale  1
Affiliations

    PMID: 32464969 DOI: 10.1016/j.healun.2020.01.1128

Abstract

Purpose: The advent of anti-viral therapy for HBV has made it possible to expand the donor pool for heart transplant recipients. Little is known in long term outcomes of recipients who receive HBV+ donor hearts. We sought to explore long-term transplant outcomes in recipients who received HBV+ donor hearts compared to those who received HBV- donor hearts.

Methods: UNOS registry was queried and identified 1,141 patients who received a heart transplant from hepatitis B core antibody (HBcAb)+ donors and 53,192 patients who received a heart transplant from HBcAb- donors. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, diabetes, ethnicity, ischemic time, dialysis, life support, waitlist time and HLA mismatch. Kaplan-Meier survival curves were generated comparing survival outcomes in patients post-HT with HBcAb+ donor to patients post-HT with HBcAb- donor.

Results: There were 1141 patients in the donor HBV+ cohort and 53,192 patients in the donor HBV- cohort. HBV+ cohort were younger (p<0.001) but just as likely to have diabetes, be on dialysis, and have similar smoking status compared to HBV- cohort. Patients required similar amounts of support, including VAD and mechanical ventilation, except for greater frequency of IABP in the HBV+ cohort (p=0.004). Ischemic time was increased in the HBV+ cohort (p<0.001). No difference in waitlist time was observed between cohorts. Overall survival in the HBV- donor cohort at 1, 5 and 10 years post-HT was 88, 74, and 57%, respectively; in the HBV+ donor cohort, survival at 1, 5 and 10 years post-HT was 85, 71, and 52%, respectively (Figure, log rank p=0.0001).

Conclusion: Use of HBV+ donors in heart transplantation was associated with worse overall survival compared to use of HBV- donors. Further study is warranted to better understand the implications of these findings.

Copyright © 2020. Published by Elsevier Inc.

StephenW

接受乙型肝炎病毒（HBV）阳性供体心脏的患者的心脏移植结果
P A Genyk 1，G S Liu 1，J Nattiv 1，P Banankhah 1，J P Li 1，P A Kingsford 1，A Wolfson 2，D Vucicevic 3，A S Vaidya 1，E C DePasquale 1
隶属关系

    PMID：32464969 DOI：10.1016 / j.healun.2020.01.1128

抽象

目的：抗病毒治疗HBV的出现使扩大心脏移植接受者的供体库成为可能。接受HBV +供体心脏的接受者的长期结局知之甚少。我们试图探讨接受HBV +供体心脏的接受者与接受HBV-供体心脏的接受者的长期移植结局。

方法：查询UNOS注册中心，确定1141例接受乙肝核心抗体（HBcAb）+供体心脏移植的患者和53192例接受HBcAb-供体心脏移植的患者。对年龄，性别，糖尿病，种族，缺血时间，透析，生命支持，候补时间和HLA失配进行了多因素Cox比例风险回归分析调整。产生Kaplan-Meier生存曲线，比较了HBcAb +供体的HT患者与HBcAb供体的HT患者的生存结果。

结果：供者HBV +队列有1141例患者，供者HBV-队列有53192例患者。 HBV +人群较年轻（p <0.001），但与HBV-人群相比，患糖尿病，透析和吸烟状况相似。患者需要类似量的支持，包括VAD和机械通气，但HBV +组中IABP的发生频率更高（p = 0.004）。 HBV +队列的缺血时间增加（p <0.001）。队列之间的等待列表时间没有差异。 HT后1、5和10年，HBV供者队列的总生存率分别为88％，74％和57％。在HBV +供者队列中，HT后1年，5年和10年的生存率分别为85％，71％和52％（图，对数秩p = 0.0001）。

结论：与使用HBV-供体相比，在心脏移植中使用HBV +供体与较差的总生存期有关。有必要进一步研究以更好地理解这些发现的含义。

版权所有©2020。由Elsevier Inc.发布。