Recipients with blood group A associated with longer survival rates in cardiac valvular bioprostheses

Background: Pigs/bovines sharewith humans some of the antigens present on cardiac valves. Two such antigens are: the major xenogenic Ag, “Gal” present in all pig/bovine very close to human B-antigen of ABO-blood-group system; the minorAg, pig histo-blood-group AH-antigen identical to human AH-antigen and present by some animals.
We hypothesize that these antigens maymodify the immunogenicity of the bioprosthesis and also its longevity. ABO distribution may vary between patients with low (b6 years) and hig (≥15 years) bioprostheses longevity.

Methods: Single-centre registry study (Paris, France) including all degenerative porcine bioprostheses (mostly Carpentier-Edwards 2nd/3rd generation heart valves) explanted between 1985 and 1998 and some bovine bioprostheses. For period 1998–2014, all porcine bioprostheses with longevity ≥13 years (follow-up ≥29 years). Important predictive factors for bioprosthesis longevity: number, site of implantation, age were collected.
Blood group and other variableswere entered into an ordinal logistic regression analysismodel predicting valve longevity, categorized as low (b6 years), medium (6–14.9 years), and high (≥15 years).

Findings: Longevity and ABO-blood group were obtained for 483 explanted porcine bioprostheses.Mean longevitywas 10.2±3.9 years [0–28] and significantly higher for A-patients than others (P=0.009). Usingmultivariate
analysis, group A was a strong predictive factor of longevity (OR 2.09; P b 0.001). For the 64 explanted bovine bioprosthesis with low/medium longevity, the association, with A-group was even more significant.

Interpretation: Patients of A-group but not B have a higher longevity of their bioprostheses. Future graft-host phenotyping and matching may give rise to a new generation of long-lasting bioprosthesis for implantation in
humans, especially for the younger population.
Fund: None.

2019- Schussler et al

Donnez votre avis