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Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls

AIMS: Due to the shortage of heart donors, increasing numbers of heart transplantation (HTx) candidates are receiving long‐term mechanical circulatory support (MCS) as bridge‐to‐transplantation. Treatment with MCS is associated with increased formation of anti‐human leukocyte antigen antibodies (all...

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Autores principales: Bartfay, Sven‐Erik, Bobbio, Emanuele, Esmaily, Sorosh, Bergh, Niklas, Holgersson, Jan, Dellgren, Göran, Bollano, Entela, Karason, Kristjan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375086/
https://www.ncbi.nlm.nih.gov/pubmed/37343937
http://dx.doi.org/10.1002/ehf2.14439
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author Bartfay, Sven‐Erik
Bobbio, Emanuele
Esmaily, Sorosh
Bergh, Niklas
Holgersson, Jan
Dellgren, Göran
Bollano, Entela
Karason, Kristjan
author_facet Bartfay, Sven‐Erik
Bobbio, Emanuele
Esmaily, Sorosh
Bergh, Niklas
Holgersson, Jan
Dellgren, Göran
Bollano, Entela
Karason, Kristjan
author_sort Bartfay, Sven‐Erik
collection PubMed
description AIMS: Due to the shortage of heart donors, increasing numbers of heart transplantation (HTx) candidates are receiving long‐term mechanical circulatory support (MCS) as bridge‐to‐transplantation. Treatment with MCS is associated with increased formation of anti‐human leukocyte antigen antibodies (allosensitization), but whether this affects post‐HTx outcomes is unclear. METHODS AND RESULTS: We included all adult patients who received long‐term MCS as bridge‐to‐transplantation and underwent subsequent HTx at our centre between 2008 and 2018. We also enrolled medically treated HTx recipients without prior MCS as controls. These controls were matched by age, sex, diagnosis, and transplantation era. Outcome parameters were compared between the two study groups. A total of 126 patients (48 ± 15 years, 84% male) were included of whom 64 were bridged with MCS and 62 were matched controls. Pre‐HTx allosensitization occurred more frequently in the MCS group than in the control group (27% vs. 11%, P = 0.03). At post‐HTx year 10, the overall survival probability was 84% among patients treated with MCS and 90% among those medically managed (P = 0.32). At post‐HTx year 1, freedom from treated rejections (≥ISHLT 2R) was 69% in the MCS group and 70% in the control group (P = 0.94); and freedom from any rejection was 8% and 5%, respectively (P = 0.98). There were no differences in renal function or cardiac allograft vasculopathy (grade ≥ 1) between groups at 1, 3, and 5 years post‐HTx. CONCLUSIONS: Although patients treated with MCS had a higher frequency of pre‐HTx allosensitization, there were no significant differences in post‐HTx graft survival, biopsy‐proven rejections, or renal function as compared with patients not bridged with MCS.
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spelling pubmed-103750862023-07-29 Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls Bartfay, Sven‐Erik Bobbio, Emanuele Esmaily, Sorosh Bergh, Niklas Holgersson, Jan Dellgren, Göran Bollano, Entela Karason, Kristjan ESC Heart Fail Original Articles AIMS: Due to the shortage of heart donors, increasing numbers of heart transplantation (HTx) candidates are receiving long‐term mechanical circulatory support (MCS) as bridge‐to‐transplantation. Treatment with MCS is associated with increased formation of anti‐human leukocyte antigen antibodies (allosensitization), but whether this affects post‐HTx outcomes is unclear. METHODS AND RESULTS: We included all adult patients who received long‐term MCS as bridge‐to‐transplantation and underwent subsequent HTx at our centre between 2008 and 2018. We also enrolled medically treated HTx recipients without prior MCS as controls. These controls were matched by age, sex, diagnosis, and transplantation era. Outcome parameters were compared between the two study groups. A total of 126 patients (48 ± 15 years, 84% male) were included of whom 64 were bridged with MCS and 62 were matched controls. Pre‐HTx allosensitization occurred more frequently in the MCS group than in the control group (27% vs. 11%, P = 0.03). At post‐HTx year 10, the overall survival probability was 84% among patients treated with MCS and 90% among those medically managed (P = 0.32). At post‐HTx year 1, freedom from treated rejections (≥ISHLT 2R) was 69% in the MCS group and 70% in the control group (P = 0.94); and freedom from any rejection was 8% and 5%, respectively (P = 0.98). There were no differences in renal function or cardiac allograft vasculopathy (grade ≥ 1) between groups at 1, 3, and 5 years post‐HTx. CONCLUSIONS: Although patients treated with MCS had a higher frequency of pre‐HTx allosensitization, there were no significant differences in post‐HTx graft survival, biopsy‐proven rejections, or renal function as compared with patients not bridged with MCS. John Wiley and Sons Inc. 2023-06-21 /pmc/articles/PMC10375086/ /pubmed/37343937 http://dx.doi.org/10.1002/ehf2.14439 Text en © 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Bartfay, Sven‐Erik
Bobbio, Emanuele
Esmaily, Sorosh
Bergh, Niklas
Holgersson, Jan
Dellgren, Göran
Bollano, Entela
Karason, Kristjan
Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
title Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
title_full Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
title_fullStr Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
title_full_unstemmed Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
title_short Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
title_sort heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375086/
https://www.ncbi.nlm.nih.gov/pubmed/37343937
http://dx.doi.org/10.1002/ehf2.14439
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