Haverich A, Gorler H
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
Transplant Proc. 2004 Mar;36(2 Suppl):314S-317S. doi: 10.1016/j.transproceed.2004.01.048.
The introduction of cyclosporine into clinical practice of thoracic organ transplantation had a dramatic and positive effect on both short- and long-term survival. Today, the majority of patients are still treated with this drug, and different immunosuppressive combination therapies have further resulted in improved long-term survival. Such combinations to calcineurin inhibitors include prednisolone, mycophenolate mofetil, azathioprine, and Rapamycin. Based on data from our own institution 1- and 5-year survival rates of 86% and 78% can be obtained after heart transplantation and 76% and 59% after lung transplantation. Causes of death are described. Future immunosuppressive strategies will have to concentrate further on the omission of organ-damaging side effects. Also, not a single compound or combination for immunosuppression after thoracic organ transplantation has proved to be effective in cases with chronic rejection (eg, transplant vasculopathy in heart transplantation and bronchiolitis obliterans in lung transplantation). Moreover, with current survival data in mind, quality of life has to be considered a major focus for future designs of immunosuppressive protocols.
环孢素引入胸器官移植临床实践对短期和长期存活都产生了显著的积极影响。如今，大多数患者仍使用这种药物治疗，不同的免疫抑制联合疗法进一步提高了长期存活率。此类与钙调神经磷酸酶抑制剂的联合用药包括泼尼松龙、霉酚酸酯、硫唑嘌呤和雷帕霉素。根据我们自己机构的数据，心脏移植后1年和5年生存率分别可达86%和78%，肺移植后分别为76%和59%。文中描述了死亡原因。未来的免疫抑制策略将不得不进一步专注于避免器官损伤性副作用。此外，对于胸器官移植后的免疫抑制，没有一种单一化合物或联合用药在慢性排斥反应（如心脏移植中的移植血管病变和肺移植中的闭塞性细支气管炎）病例中被证明是有效的。此外，考虑到当前的存活数据，生活质量必须被视为未来免疫抑制方案设计的主要关注点。
