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Impact of Sex in the Efficacy of Perioperative Desensitization Procedures in Heart Transplantation: A Retrospective Cohort Study.
- Source :
-
Frontiers in immunology [Front Immunol] 2021 Jul 07; Vol. 12, pp. 659303. Date of Electronic Publication: 2021 Jul 07 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Background: Sensitized patients, i.e. recipients with preformed donor-specific HLA antibodies (pfDSA), are at high-risk of developing antibody-mediated rejections (AMR) and dying after heart transplantation (HTx). Perioperative desensitization procedures are associated with better outcomes but can cause sensitization, which may influence their efficacy.<br />Methods: In sensitized patients (pfDSA>1000 mean immunofluorescence (MFI) units), we assessed the effect of perioperative desensitization by comparing treated patients to a historical control cohort. Multivariable survival analyses were performed on the time to main outcome, a composite of death and biopsy-proven AMR with 5-year follow-up.<br />Results: The study included 68 patients: 31 control and 37 treated patients. There was no difference in preoperative variables between the two groups, including cumulative pfDSA [4026 (1788;8725) vs 4560 (3162;13392) MFI units, p =0.28]. The cause of sensitization was pregnancy in 24/68, 35.3%, transfusion in 61/68, 89.7%, and previous HTx in 4/68, 5.9% patients. Multivariable analysis yielded significant protective association between desensitization and events (adjusted (adj.) hazard ratio (HR)=0.44 (95% confidence interval (95CI)=0.25-0.79), p =0.006) and deleterious association between cumulative pfDSA and events [per 1000-MFI increase, adj.HR=1.028 (1.002-1.053), p=0.031]. There was a sex-difference in the efficacy of desensitization: in men (n=35), the benefit was significant [unadj.HR=0.33 (95CI=0.14-0.78); p=0.01], but not in women (n=33) [unadj.HR=0.52 (0.23-1.17), p=0.11]. In terms of the number of patients treated, in men, 2.1 of patients that were treated prevented 1 event, while in women, 3.1 required treatment to prevent 1 event.<br />Conclusion: Perioperative desensitization was associated with fewer AMR and deaths after HTx, and efficacy was more pronounced in men than women.<br />Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.<br /> (Copyright © 2021 Nguyen, Salem, Bories, Coutance, Amour, Bougle, Suberbielle, Kheav, Carmagnat, Rouvier, Kirsch, Varnous, Leprince and Saheb.)
- Subjects :
- Adult
Biomarkers
Biopsy
Female
Follow-Up Studies
Graft Rejection immunology
Graft Rejection prevention & control
Graft Rejection therapy
HLA Antigens immunology
Humans
Immunosuppressive Agents administration & dosage
Immunosuppressive Agents therapeutic use
Male
Middle Aged
Pregnancy
Prognosis
Retrospective Studies
Sex Factors
Treatment Outcome
Desensitization, Immunologic methods
Heart Transplantation adverse effects
Perioperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1664-3224
- Volume :
- 12
- Database :
- MEDLINE
- Journal :
- Frontiers in immunology
- Publication Type :
- Academic Journal
- Accession number :
- 34305891
- Full Text :
- https://doi.org/10.3389/fimmu.2021.659303