Gajjar Nupoor A, Kobashigawa Jon A, Laks Hillel, Espejo-Vassilakis Maria, Fishbein Michael C
Division of Anatomic Pathology, University of California at Los Angeles Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
Cardiovasc Pathol. 2003 Mar-Apr;12(2):73-6. doi: 10.1016/s1054-8807(02)00164-3.
Whether FK506 or cyclosporin is better for chronic immunosuppression in heart transplant patients has been debated. We examined endomyocardial biopsies from patients treated with these two drugs to determine if there was a difference in frequency of histologic cellular rejection episodes and Quilty lesions. The Quilty lesion (AKA cyclosporin effect) may be an atypical form of rejection, and is thought to be related to the use of cyclosporin immunosuppression.
We reviewed 1067 endomyocardial biopsies from 65 patients who were assigned FK506 or cyclosporin after heart transplantation.
The number of episodes of rejection (162 FK506 vs. 145 cyclosporin) was the same. However, when compared to cyclosporin treatment, FK506 was associated with significantly more Quilty A lesions and fewer Quilty B lesions.
FK506 appears to prevent some Quilty A lesions from progressing to Quilty B lesions. Since Quilty B lesion is associated with myocyte injury and Quilty A is not, this effect of FK506 could be associated with improved long-term graft function.
关于FK506和环孢素哪种更适合心脏移植患者的慢性免疫抑制一直存在争议。我们检查了接受这两种药物治疗的患者的心内膜活检样本，以确定组织学细胞排斥反应发作频率和奎尔蒂病变是否存在差异。奎尔蒂病变（又称环孢素效应）可能是一种非典型的排斥反应形式，被认为与使用环孢素免疫抑制有关。
我们回顾了65例心脏移植后被分配使用FK506或环孢素的患者的1067份心内膜活检样本。
排斥反应发作次数相同（FK506组162次，环孢素组145次）。然而，与环孢素治疗相比，FK506与显著更多的奎尔蒂A病变和更少的奎尔蒂B病变相关。
FK506似乎能阻止一些奎尔蒂A病变发展为奎尔蒂B病变。由于奎尔蒂B病变与心肌细胞损伤有关而奎尔蒂A病变无关，FK506的这种作用可能与改善长期移植物功能有关。
