Contemporary Immunosuppression Management and 1-Year Outcomes in Dual Organ Heart Transplantation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-08-08 DOI:10.1111/ctr.15420

Xinyi Huang, David Salerno, Danielle Kovac, Jenna Scheffert, Jessica Hedvat, Bayleigh Carver, Jason Choe, Tara Shertel, Melana Yuzefpolskaya, Paolo C. Colombo, Douglas L. Jennings

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Abstract

Background

There have been limited reports on immunosuppression strategies and outcomes in dual organ heart transplant populations, primarily from before the 2018 United Network for Organ Sharing (UNOS) heart allocation policy change. Recent data suggested that outcomes with heart–lung and heart–liver transplants remained comparable in the new allocation era, yet heart–kidney recipients have worse 1-year survival.

Methods

This single-center retrospective study evaluated adult heart–kidney, heart–liver, and heart–lung transplant recipients from September 2019 to May 2023. Immunosuppression regimen, infectious complications, and graft outcomes were collected for 12 months.

Results

A total of 36 patients (kidney n = 20, liver n = 9, and lung n = 7) were included in this study. Basiliximab was the most commonly employed induction strategy across the organ groups (12/20 in kidney, 4/9 in liver, and 7/7 in lung). All patients were on triple immunosuppression at 12 months posttransplant with prednisone wean achieved in one heart–liver recipient. Infection complications were frequently reported (95% kidney, 75% liver, 100% lung group). One patient went back to dialysis due to focal segmental glomerulosclerosis. One chronic lung allograft dysfunction was reported, but no other severe biopsy-proven rejection or retransplant was reported. The 1-year survival was 85% (17/20) in heart–kidney, 78% (7/9) in heart–liver, and 86% (6/7) in heart–lung recipients.

Conclusion

This study summarized real-world immunosuppression strategies and outcomes in dual organ heart transplant recipients.

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双器官心脏移植手术中的现代免疫抑制管理和 1 年疗效。

背景：关于双器官心脏移植人群的免疫抑制策略和结果的报道很有限，主要是2018年器官共享联合网络（UNOS）心脏分配政策改变之前的报道。最近的数据表明，在新的分配时代，心肺移植和心肝移植的结果仍具有可比性，但心肾受者的1年存活率较低：这项单中心回顾性研究对 2019 年 9 月至 2023 年 5 月期间的成年心肾、心肝和心肺移植受者进行了评估。研究收集了12个月的免疫抑制方案、感染并发症和移植结果：本研究共纳入 36 例患者（肾脏 20 例、肝脏 9 例、肺脏 7 例）。在各器官组中，巴西利西单抗是最常用的诱导策略（肾脏12/20例，肝脏4/9例，肺脏7/7例）。所有患者在移植后12个月时都接受了三联免疫抑制，其中一名心肝受者实现了泼尼松断药。感染并发症屡见报端（肾组 95%、肝组 75%、肺组 100%）。一名患者因局灶节段性肾小球硬化而再次接受透析治疗。据报道，有一名患者出现了慢性肺异体移植功能障碍，但没有其他经活检证实的严重排斥反应或再移植的报道。心肾受者的1年存活率为85%（17/20），心肝受者的1年存活率为78%（7/9），心肺受者的1年存活率为86%（6/7）：本研究总结了现实世界中双器官心脏移植受者的免疫抑制策略和结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.