BACKGROUND

Evidence from animal studies and small case series suggests that primary graft dysfunction occurs less often following combined organ transplantation than following isolated organ transplantation. In this large-scale national registry study, we aimed to investigate whether survival and the rates of bronchiolitis obliterans syndrome (BOS) and coronary allograft vasculopathy (CAV) are affected by simultaneous heart and/or lung transplantation (HLTx).

METHODS

Clinical data from the United Network of Organ Sharing database were retrospectively reviewed to identify transplant-naive patients who had undergone heart and/or lung transplantation between 1987 and 2016. The comparisons were conducted for isolated vs combined organ transplant. The outcomes included all-cause mortality, as well as the incidence of BOS and CAV

RESULTS

Of the 98,310 patients reviewed, 63,976, 1,189, and 33,145 had received isolated heart transplantation (iHTx) (65%), HLTx (1%), and isolated lung transplantation (iLTx) (34%), respectively. In the early post-operative period, the mortality rates were higher after HLTx than after iHTx or iLTx (on crude and propensity score–matched analyses). However, the adjusted hazard risk for mortality associated with HLTx was significantly lower relative to the iLTx-associated risk beyond 3 years postoperatively, and similar relative to the iHTx-associated risk beyond 7 years postoperatively. On both crude and adjusted analyses, the incidence of BOS and CAV was significantly lower after HLTx than after iHTx or iLTx (p < 0.001 for all comparisons).

CONCLUSIONS

Combined (rather than single) organ transplantation may provide immunoprotective benefits enhancing long-term survival and attenuating the risk of BOS and CAV.

中文翻译：

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心脏和肺部联合移植对闭塞性细支气管炎综合征，心脏同种异体血管病变和长期生存的影响。

背景

来自动物研究和小病例研究的证据表明，与单独器官移植相比，联合器官移植后原发性移植物功能障碍的发生频率更低。在这项大规模的国家注册研究中，我们旨在调查同时心脏和/或肺移植（HLTx）是否会影响存活率和闭塞性细支气管炎综合征（BOS）和同种异体冠状动脉血管病（CAV）的发生率。

方法

回顾性地回顾了来自器官共享联合网络数据库的临床数据，以鉴定在1987年至2016年之间接受过心脏和/或肺移植的未移植患者。比较了分离的和联合的器官移植。结果包括全因死亡率以及BOS和CAV的发生率

结果

在回顾的98,310名患者中，分别有63,976、1,189和33,145例接受了离体心脏移植（iHTx）（65％），HLTx（1％）和离体肺移植（iLTx）（34％）。在术后早期，HLTx术后的死亡率高于iHTx或iLTx术后的死亡率（根据原油和倾向得分匹配的分析）。但是，相对于术后iLTx相关风险，术后3年内与HLTx相关的死亡率调整后的危险显着降低，并且相对于术后7年以上iHTx相关风险，具有相似的风险。在粗略分析和校正分析中，HLTx后BOS和CAV的发生率均显着低于iHTx或iLTx后（所有比较的p <0.001）。

结论

联合（而非单次）器官移植可提供免疫保护作用，从而提高长期生存率并降低BOS和CAV的风险。