Patel Jignesh K, Kobashigawa Jon A
David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Semin Thorac Cardiovasc Surg. 2004 Winter;16(4):378-85. doi: 10.1053/j.semtcvs.2004.09.006.
The success of cardiac transplantation has been largely attributable to the development of effective immunosuppressive regimens. The calcineurin inhibitors were pivotal in reducing the frequency of acute rejection and improving early survival. Newer agents, including mycophenolate mofetil and proliferation signal inhibitors, show some promise in further reducing episodes of acute allograft rejection and also having a significant impact on reducing transplant vasculopathy. The role of cytolytic induction therapy remains unclear, although its use may be most appropriate in the high risk presensitized transplant recipient. While the endomyocardial biopsy remains the gold standard for the diagnosis of acute allograft rejection, its invasive nature makes the test suboptimal. The presence of biopsy 'negative' rejection has also led to an appreciation for the role of antibody-mediated rejection in cardiac allograft dysfunction. Effective noninvasive evaluation of allograft rejection remains the ultimate challenge. While imaging technologies have some utility because of their ease of use, more sophisticated techniques such as gene-expession analysis from peripheral blood may show the greatest promise. Management of established acute allograft rejection has significantly improved with our understanding of the immune mechanisms involved. Therapies may be targeted specifically at cellular or humoral components of the immune system.
心脏移植的成功很大程度上归功于有效免疫抑制方案的发展。钙调神经磷酸酶抑制剂在降低急性排斥反应频率和提高早期生存率方面起着关键作用。包括霉酚酸酯和增殖信号抑制剂在内的新型药物在进一步减少急性移植物排斥反应发作以及对减少移植血管病变产生重大影响方面显示出一些前景。细胞溶解诱导疗法的作用仍不明确，尽管其使用可能最适合于高风险的致敏移植受者。虽然心内膜心肌活检仍然是诊断急性移植物排斥反应的金标准，但其侵入性使得该检查并非最佳选择。活检“阴性”排斥反应的存在也使人们认识到抗体介导的排斥反应在心脏移植物功能障碍中的作用。对移植物排斥反应进行有效的非侵入性评估仍然是最终挑战。虽然成像技术因其易于使用而有一定作用，但更复杂的技术，如外周血基因表达分析，可能显示出最大的前景。随着我们对所涉及免疫机制的了解，已确立的急性移植物排斥反应的管理有了显著改善。治疗可能专门针对免疫系统的细胞或体液成分。
