AIMS: One of the proposed limitations of left ventricular assist device (LVAD) therapy is high degree of sensitization. Apart from human leukocyte antigen (HLA), antibodies against Angiotensin II Type 1 Receptor (AT1R) have been associated with adverse outcomes. The purpose of this study was to compare complications and survival of anti - AT1R positive versus negative Heart Mate II (HMII) recipients. METHODS: Altogether 96 patients received HMII at our institution between 2008 and 2012. These were stratified into three groups: antibody positive before implantation (AT1R+), antibody conversion during support (AT1R-/+) and patients who remained antibody negative (AT1R-). Survival, major on-device adverse events and post-transplant rejections were assessed with Kaplan-Meier and log-rank tests. RESULTS: Two year on-device and overall survival was 78 ± 12% and 75 ± 10% in AT1R-, 60 ± 23% and 60 ± 15% in AT1R+ and 92 ± 6% and 87 ± 5% in AT1R-/+ group (P = 0.409, P = 0.185). Freedom from major adverse event at two years for AT1R-, AT1R+ and AT1R-/+ was 49 ± 14%, 53 ± 16% and 41 ± 11% (P = 0.875). Freedom from rejection was 63 ± 17% in patients who were both anti-AT1R and HLA negative and 65 ± 13% in those who were antibody positive (P = 0.788). CONCLUSION: Patients who were anti-AT1R antibody positive had similar on-device survival and rate of complications in comparison to those who were antibody negative. In transplanted patients, there were no differences in the overall survival and rejection between the groups.
- Klíčová slova
- Angiotensin II Type 1 Receptor, Heart Mate II, LVAD, heart transplantation,
- MeSH
- dospělí MeSH
- HLA antigeny imunologie MeSH
- infekce spojené s protézou etiologie mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci nervového systému etiologie mortalita MeSH
- podpůrné srdeční systémy škodlivé účinky MeSH
- pooperační krvácení etiologie MeSH
- protilátky metabolismus MeSH
- receptor angiotensinu typ 1 imunologie MeSH
- rejekce štěpu imunologie MeSH
- selhání protézy MeSH
- srdeční selhání imunologie mortalita terapie MeSH
- transplantace srdce mortalita MeSH
- transplantační imunologie imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Názvy látek
- HLA antigeny MeSH
- protilátky MeSH
- receptor angiotensinu typ 1 MeSH
OBJECTIVES: Antibodies targeting angiotensin II type 1 receptor (AT1R) have been associated with malignant hypertension, autoimmune diseases and acute rejection and graft loss in solid organ transplantation. The aim of our study was to assess the impact of anti-AT1R antibodies on survival and incidence of acute cellular rejection (ACR) and pathology antibody-mediated rejection (pAMR) in a population of heart transplant recipients who were bridged to transplantation with a durable mechanical assist device Heart Mate II. METHODS: Sera of 69 consecutive heart transplant recipients transplanted between October 2008 and August 2014 were tested for the presence of angiotensin II type 1 receptor antibodies before Heart Mate II device implantation and at the time of transplantation. Overall survival and post-transplant rejection-free survival were compared between antibody-negative and antibody-positive recipients using Kaplan-Meier and log-rank tests. RESULTS: Anti-AT1R antibodies were present in 8 patients (11.6%) before Heart Mate II implantation. During the left ventricular assist device (LVAD) bridging, 44 patients (63.8%) who were initially anti-AT1R antibody-negative became positive, leaving 17 (24.6%) anti-AT1R antibody-negative patients at the time of transplantation for all comparisons. One- and 5-year survival was 88 ± 8 and 76 ± 10% for anti-AT1R antibody-negative and 87 ± 5 and 81 ± 7% for anti-AT1R antibody-positive patients, respectively (P = 0.582). Freedom from ACR at 1 year was 68 ± 12% for anti-AT1R-negative and 75 ± 6% for anti-AT1R-positive recipients (P = 0.218). None of the anti-AT1R-negative patients developed AMR 1 year post-transplantation, whereas freedom from pAMR in anti-AT1R-positive recipients was 98 ± 2% (P = 0.198). CONCLUSIONS: Our data showed no difference in the overall post-heart transplant survival and freedom from acute cellular and antibody-mediated rejection between anti-AT1R-negative and anti-AT1R-positive recipients. Further research is needed to assess the role of anti-AT1R antibodies in the risk stratification of LVAD-bridged recipients on the post-heart transplantation outcomes.
- Klíčová slova
- Angiotensin II type 1 receptor, Heart transplantation, Mechanical circulatory support,
- MeSH
- akutní nemoc MeSH
- autoprotilátky krev MeSH
- buněčná imunita MeSH
- časové faktory MeSH
- dospělí MeSH
- humorální imunita MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- přežívání štěpu MeSH
- receptor angiotensinu typ 1 imunologie MeSH
- rejekce štěpu imunologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- srdeční selhání krev diagnóza imunologie chirurgie terapie MeSH
- transplantace srdce * škodlivé účinky mortalita MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Názvy látek
- AGTR1 protein, human MeSH Prohlížeč
- autoprotilátky MeSH
- receptor angiotensinu typ 1 MeSH
Atherosclerosis has been recognized as an inflammatory/autoimmune disease. The long-standing low-grade inflammation which fuels its development is primarily focused on the components of the vessel wall. Originally, inflammation in atherogenesis was supposed to be driven by the pro-inflammatory Th1 cellular and cytokine immune response. On the basis of accumulating evidence, this view has been re-evaluated to include the Th17/Th1 axis which is shared by most diseases of sterile inflammation. The anti-inflammatory Th2 cellular and cytokine immune response is initiated concomitantly with the former two, the latter dampening their harmful reactions which culminate in full-blown atherosclerosis. Interleukin-33, a novel member of the IL-1 cytokine superfamily, was suggested to take part in the anti-atherogenic response by mediating the Th1-to-Th2 switch of the immune reactions. However, IL-33 is a multifaceted mediator with both pro- and anti-inflammatory activities, also called a "dual factor" or a "Janus face" interleukin. IL-33 occurs both in an extracellular (cytokine-like) and in a nuclear-bound (transcription factor-like) form, each of them performing distinct activities of their own. This review article presents the latest data relevant to IL-33's role in atherosclerosis and cardiac diseases as perceived by a cardiologist and a cardiac surgeon.
- Klíčová slova
- IL-33, Th1, Th17, Th2, atherosclerosis, cytokine, inflammation, transcription factor,
- MeSH
- ateroskleróza imunologie patologie MeSH
- buňky Th17 imunologie patologie MeSH
- interleukin 33 imunologie MeSH
- lidé MeSH
- srdeční selhání imunologie patologie MeSH
- Th1 buňky imunologie patologie MeSH
- Th2 buňky imunologie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- IL33 protein, human MeSH Prohlížeč
- interleukin 33 MeSH
- MeSH
- dítě MeSH
- gama-globuliny aplikace a dávkování MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- osteomyelitida imunologie MeSH
- předškolní dítě MeSH
- protilátky anti-idiotypické analýza MeSH
- srdeční selhání imunologie MeSH
- tvorba protilátek * MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- gama-globuliny MeSH
- protilátky anti-idiotypické MeSH
