BACKGROUND Prior studies have shown reduced development of cardiac allograft vasculopathy (CAV) in multiorgan transplant recipients. The aim of this study was to compare the incidence of CAV between isolated heart transplants and simultaneous multiorgan heart transplants in the contemporary era. METHODS We utilized the Scientific Registry of Transplant Recipients to perform a retrospective analysis of first-time adult heart transplant recipients between January 1, 2010 and December 31, 2019 in the United States. The primary end-point was the development of angiographic CAV within 5 years of follow-up. RESULTS Among 20,591 patients included in the analysis, 1,279 (6%) underwent multiorgan heart transplantation (70% heart-kidney, 16% heart-liver, 13% heart-lung, and 1% triple-organ), and 19,312 (94%) were isolated heart transplant recipients. The average age was 53 years, and 74% were male. There were no significant between-group differences in cold ischemic time. The incidence of acute rejection during the first year after transplant was significantly lower in the multiorgan group (18% vs 33%, p < 0.01). The 5-year incidence of CAV was 33% in the isolated heart group and 27% in the multiorgan group (p < 0.0001); differences in CAV incidence were seen as early as 1 year after transplant and persisted over time. In multivariable analysis, multiorgan heart transplant recipients had a significantly lower likelihood of CAV at 5 years (hazard ratio = 0.76, 95% confidence interval: 0.66-0.88, p < 0.01). CONCLUSIONS Simultaneous multiorgan heart transplantation is associated with a significantly lower long-term risk of angiographic CAV compared with isolated heart transplantation in the contemporary era.

中文翻译：

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美国同时多器官移植和离体心脏移植受者之间心脏同种异体移植血管病变发生率的比较。


背景先前的研究表明，多器官移植受者发生心脏同种异体移植血管病（CAV）的情况减少。本研究的目的是比较当代离体心脏移植和同步多器官心脏移植之间的 CAV 发生率。方法 我们利用移植受者科学登记系统对 2010 年 1 月 1 日至 2019 年 12 月 31 日期间美国首次成人心脏移植受者进行回顾性分析。主要终点是随访 5 年内发生血管造影 CAV。结果 在分析中纳入的 20,591 名患者中，1,279 名患者（6%）接受了多器官心脏移植（70% 心肾移植，16% 心肝移植，13% 心肺移植，1% 三器官移植），19,312 名患者（94% ）是孤立的心脏移植受者。平均年龄为53岁，其中74%为男性。冷缺血时间没有显着组间差异。多器官组移植后第一年的急性排斥反应发生率显着较低（18% vs 33%，p < 0.01）。离体心脏组 CAV 的 5 年发病率为 33%，多器官组为 27% (p < 0.0001)； CAV 发生率的差异早在移植后 1 年就已出现，并随着时间的推移持续存在。在多变量分析中，多器官心脏移植受者 5 年发生 CAV 的可能性显着降低（风险比 = 0.76，95% 置信区间：0.66-0.88，p < 0.01）。结论 与当代的离体心脏移植相比，同时多器官心脏移植与血管造影 CAV 的长期风险显着降低相关。