BACKGROUND Primary graft dysfunction (PGD) remains the leading cause of 30-day mortality post-heart transplantation (HTx). HTx recipients experiencing severe PGD have been found to have high levels of circulating proteins associated with PGD occurrence and post-HTx survival. Whether treating these patients with therapeutic plasma exchange (TPE) can attenuate ongoing immunological and inflammatory processes and improve post-transplant outcomes has not been well-investigated. Therefore, we aim to examine the impact of treatment with TPE on 30-day and 1-year clinical outcomes of patients experiencing severe PGD post-HTx. METHODS Between 2010 and 2022, we included 42 HTx patients who developed severe PGD. All included patients were placed on veno-arterial extracorporeal membrane oxygenation. We divided these patients into those who received TPE and those who did not (by physician choice). Endpoints included 30-day and 1-year survival, as well as 1-year-freedom from Any-treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR), biopsy negative rejection (BNR), cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), and freedom from left ventricular dysfunction (LVD) at 1-year post-HTx. RESULTS Compared to patients who did not receive TPE, those managed with TPE had increased survival rates at 30 days (78.1% vs. 40%, p = 0.007) and at 1-year post-HTx (56.25% vs. 30% p = 0.035). However, no statistically significant differences were recorded in other outcomes of interest, including 1-year freedom from CAV, ATR, ACR, AMR, BNR, NF-MACE, or LVD. CONCLUSION TPE may serve as a promising therapeutic approach in HTx recipients experiencing severe PGD.

中文翻译：

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治疗性血浆置换与经历严重原发性移植物功能障碍的心脏移植受者的生存率增加有关。


背景 原发性移植物功能障碍 （PGD） 仍然是心脏移植后 （HTx） 30 天死亡率的主要原因。已发现患有严重 PGD 的 HTx 受体具有与 PGD 发生和 HTx 后生存相关的高水平循环蛋白。用治疗性血浆置换 （TPE） 治疗这些患者是否可以减轻正在进行的免疫和炎症过程并改善移植后预后尚未得到充分研究。因此，我们旨在检查 TPE 治疗对 HTx 后严重 PGD 患者 30 天和 1 年临床结果的影响。方法 在 2010 和 2022 年期间，我们纳入了 42 例发展为严重 PGD 的 HTx 患者。所有纳入的患者均接受静脉-动脉体外膜肺氧合。我们将这些患者分为接受 TPE 的患者和未接受 TPE 的患者（根据医生选择）。终点包括 30 天和 1 年生存率，以及 1 年无任何治疗排斥反应 （ATR） 、急性细胞排斥反应 （ACR）、抗体介导的排斥反应 （AMR）、活检阴性排斥反应 （BNR）、同种异体移植心脏血管病变 （CAV） 、非致命性主要不良心脏事件 （NF-MACE） 和 HTx 后 1 年无左心室功能障碍 （LVD）。结果与未接受 TPE 的患者相比，接受 TPE 治疗的患者在 30 天 （78.1% vs. 40%，p = 0.007） 和 HTx 后 1 年 （56.25% vs. 30% p = 0.035） 的生存率增加。然而，在其他感兴趣的结局中没有统计学上的显著差异，包括无 CAV、ATR、ACR、AMR、BNR、NF-MACE 或 LVD 的 1 年。结论 TPE 可能作为患有严重 PGD 的 HTx 受者的一种有前途的治疗方法。