Huang Xue-shan, Chen Dao-zhong, Chen Liang-wan, Li Zeng-qi, Liao Chong-xian
Department of Cardiovascular Surgery and Fujian Institute of Cardiothoracic Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou 350001, China.
Di Yi Jun Yi Da Xue Xue Bao. 2004 Feb;24(2):126-8.
To review the clinical experience of immunosuppression induction therapy to prevent acute rejection in 8 patients with cardiac transplant.
Between June, 2000 and May, 2002, 8 patients with end-stage dilated cardiomyopathy undergoing orthotopic cardiac transplantation received induction therapy with two-dose daclizumab (1.0 mg/kg), given intravenously within 12 h before cardiac-transplantation surgery and two weeks thereafter, and with an initial 5-day course of intravenous antithymocyte globulin (100 mg/d) following transplantation. Cyclosporine or tacrolimus, mycophenolate mofetil or azathioprine, and prednisolone were applied for immunosuppression maintenance.
No death occurred during the follow-up. Routine endomyocardial biopsies in all cases performed in the early stage detected only mild rejection, and no acute allograft or renal dysfunction was found. Three patients developed opportunistic infection, and only one had late acute rejection in the 14th post-transplantation month.
Induction therapy with intravenous daclizumab and antithymocyte globulin is effective to prevent acute rejection and alleviate organ dysfunction in cardiac transplantation, but might increase the chance of infections.
回顾8例心脏移植患者采用免疫抑制诱导治疗预防急性排斥反应的临床经验。
2000年6月至2002年5月，8例终末期扩张型心肌病患者接受原位心脏移植，在心脏移植手术前12小时内及术后两周静脉注射两剂达利珠单抗（1.0mg/kg）进行诱导治疗，并在移植后给予初始5天疗程的静脉注射抗胸腺细胞球蛋白（100mg/d）。采用环孢素或他克莫司、霉酚酸酯或硫唑嘌呤以及泼尼松龙进行免疫抑制维持治疗。
随访期间无死亡发生。早期对所有病例进行的常规心内膜心肌活检仅检测到轻度排斥反应，未发现急性移植物或肾功能障碍。3例患者发生机会性感染，仅1例在移植后第14个月发生晚期急性排斥反应。
静脉注射达利珠单抗和抗胸腺细胞球蛋白进行诱导治疗可有效预防心脏移植中的急性排斥反应并减轻器官功能障碍，但可能增加感染几率。
