Kalp Nakli Sonrası Dekompanze Kalp Yetmezliğine Neden Olan Akut Rejeksiyonda Plazmaferezin Rolü

Year 2022, Volume: 32 Issue: 6, 719 - 723, 31.12.2022

Mehmet Karahan , Doğan Emre Sert , Abdulkadir Yılmaz , Fatih Yamac , Servet Turgut , Burcu Demırkan , Tekin Güney , Simten Dagdas , Sinan Sabit Kocabeyoğlu , Seref Alp Kucuker , Mehmet Özatik , Zeki Çatav , Erol Sener

https://doi.org/10.54005/geneltip.1203306

Abstract

Özet
Amaç: Bu çalışmada ortotopik kalp nakli (OHT) yapılan, takip sırasında dekompanze kalp yetmezliğine neden olan akut rejeksiyon ile kliniğimize başvuran ve endomiyokardiyal biyopsi (EMB) yapılamayan hastaların sonuçları değerlendirildi.
Yöntemler: Çalışmaya Aralık 1998-Kasım 2021 tarihleri arasında kliniğimizde OHT yapılıp, takip sırasında dekompanze kalp yetmezliğine neden olan akut rejeksiyon ile başvuran ve EMB uygulanamayan, IV pulse steroid + plazmaferez uygulanan 27 hasta dahil edildi. Hastaların demografik özellikleri, tedavi öncesi sol ventrikül fonksiyonları, sağkalım oranları ve mortalite nedenleri analiz edildi.
Bulgular: Hastaların 19'u (%70.4) erkekti ve yaş ortalaması 28.7 ± 14.7 (3-54) idi. OHT sonrası genel sağkalım oranları 1., 3. ve 5. yılda sırasıyla %92.6, %77.6 ve %69.4 idi. İzlemde dekompanze kalp yetmezliği ile başvuran ve pulse steroid + plazmaferez uygulanan hastaların plazmaferez sonrası 1., 3. ve 5. yılda sağkalım oranları sırasıyla %70.4, %58.8 ve %53.4 idi. Nakil sonrası median rejeksiyon süresi 19 aydı (0-113 ay). Tedavi öncesi ve sonrası sol ventrikül ejeksiyon fraksiyonları sırasıyla %25.11±%11.1 ve %52.14±%13.4 idi (p<0.05). Mortalitenin önde gelen nedeni ise sepsise neden olan pnömoni (5/13 hasta) idi.
Sonuç: EMB'nin yapılmasının mümkün olmadığı dekompanze kalp yetmezliği olan akut rejeksiyon hastalarında, IV pulse steroid tedavisine ek olarak plazmaferez uygulanması sağkalımı olumlu etkileyebilir.

Keywords

greft rejeksiyonu, kalp nakli, plazmaferez

The Role of Plasmapheresis in Acute Rejection with Decompensated Heart Failure after Heart Transplantation

Abstract

Abstract
Background/Aims: In this study, the results of patients who had orthotopic heart transplantation (OHT) in acute rejection who admitted to our clinic with decompensated heart failure and who could not undergo endomyocardial biopsy (EMB) were evaluated.

Methods: The study included 27 patients who underwent OHT in our clinic between December 1998 and November 2021, who admitted with acute rejection causing decompensated heart failure during follow-up, and who could not undergo EMB and administered IV pulse steroid plus plasmapheresis. Demographics of patients, peri-treatment left ventricular functions, survival rates and causes of mortality were analyzed.

Results: 19 (70.4%) were male and mean age was 28.7 ± 14.7 (range: 3-54). After OHT, overall survival rates were 92.6%, 77.6%, and 69.4% at 1st, 3rd and 5th year respectively. During the follow-up, the survival rates of patients who presented with decompensated heart failure and given pulse steroid plus plasmapheresis were 70.4%, 58.8%, and 53.4% at 1st, 3rd and 5th year respectively after plasmapheresis. Median rejection time after transplant was 19 months (range 0-113 months). Pre-, and post-treatment left ventricle ejection fractions were 25.11% ± 11.1%, and 52.14% ± 13.4% respectively (p<0.05). The leading causes of mortality were pneumonia causing sepsis (5/13 patients).

Conclusions: In acute rejection patients with decompensated heart failure in whom EMB is not possible, administration of plasmapheresis in addition to IV pulse steroid therapy may have a positive effect on survival in this patient group.

Keywords

graft rejection, heart transplantation, plasmapheresis

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