O'Neill J O, Taylor D O, Starling R C
Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Transplant Proc. 2004 Mar;36(2 Suppl):309S-313S. doi: 10.1016/j.transproceed.2004.01.010.
The field of cardiac transplant immunosuppression is rapidly developing and has evolved over the past 35 years. Anecdote, experience and registry based practice is giving way to an increasing bounty of well designed, randomized controlled trials which will guide future therapy. Current therapy is based on triple therapy with corticosteroids, a calcineurin inhibitor and an antimetabolite, but these regimens may be replaced by substitution or addition of newer antiproliferative agents. The true nemesis is coronary graft vasculopathy, which affects 50% of patients at 5 years and until recently had very few preventive therapeutic options. Renal toxicity remains among the most challenging adverse effects of immunosuppression to be overcome.
心脏移植免疫抑制领域发展迅速，在过去35年中不断演变。基于轶事、经验和登记处的做法正逐渐被越来越多精心设计的随机对照试验所取代，这些试验将指导未来的治疗。目前的治疗方法是采用皮质类固醇、钙调神经磷酸酶抑制剂和抗代谢物的三联疗法，但这些方案可能会被更新的抗增殖药物替代或添加所取代。真正的克星是冠状动脉移植血管病变，5年内有50%的患者受其影响，直到最近，预防性治疗选择还非常少。肾毒性仍然是免疫抑制最具挑战性的不良反应之一，有待克服。
