Clin Transplant:心脏移植后与心室辅助装置有关的感染患者的结果

2020-09-24 MedSci原创 MedSci原创

尽管在持久性机械支持生存方面取得了重大进展,但感染并发症仍然是心室辅助装置(VAD)植入后最常见的不良事件,也是移植后早期死亡的主要原因。在这项研究中,我们旨在描述当地的传染病流行病学,并回顾移植后时

尽管在持久性机械支持生存方面取得了重大进展,但感染并发症仍然是心室辅助装置(VAD)植入后最常见的不良事件,也是移植后早期死亡的主要原因。在这项研究中,我们旨在描述当地的传染病流行病学,并回顾移植后时期的短期存活率和感染发生率,并评估移植后感染事件的危险因素。

对2008年至2017年所有连续成人心脏移植患者的回顾性单中心研究。使用Kaplan-Meier方法对生存数据进行评估和总结。我们使用Fine-Gray模型量化并评估了有无感染的患者之间的发病率差异。令人感兴趣的结果是,以移植后死亡为竞争事件进行首次感染诊断的时间。

 

结果显示,在278例心脏移植患者中,有74例(26.5%)接受了LVAD植入。21名患者(28.3%)在LVAD的支持下发展为感染。与没有先前感染的LVAD支持的患者相比,BMI明显更高(31.2 vs 27.8 kg/m2,P = .03)。移植后中位随访时间为3.01年。当调整接收者的年龄、性别、高血压、糖尿病和体重指数时,心脏移植后感染竞争风险消退的重要风险因素包括LVAD感染(HR 1.94,[95%CI] 1.11-3.39,P = .020)和接受者COPD(HR 2.14,[95%CI] 1.39-3.32,P = 0.001)。

 

总之,该研究结果表明,LVAD相关感染的患者在心脏移植后发生感染并发症的风险显著增加。在该患者人群中有必要对避免诱导剂和减少维持性免疫抑制的进一步研究。

 

原始出处:

 

Yasbanoo Moayedi, Ashrit Multani, et al., Outcomes of patients with infection related to a ventricular assist device after heart transplantation. Clin Transplant. 2019 Oct;33(10):e13692. doi: 10.1111/ctr.13692.  

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    2020-12-20 xuyu
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