Reichenspurner Hermann
Department of Cardiovascular Surgery, University Hospital-Eppendorf, Hamburg, Germany.
J Heart Lung Transplant. 2005 Feb;24(2):119-30. doi: 10.1016/j.healun.2004.02.022.
Transplantation has evolved into an accepted treatment for end-stage heart or lung disease. Acute rejection, complications related to immunosuppressive protocols, and the development of chronic rejection continue to challenge the long-term success of heart and lung transplantations. Wide acceptance of tacrolimus as an important immunosuppressant in renal and hepatic transplantations has led subsequently to its investigation as primary immunosuppression in heart and lung transplant recipients, either combined with azathioprine or with the newer agents mycophenolate mofetil or rapamycin. Studies have shown that tacrolimus is an effective therapeutic alternative to cyclosporine for primary immunosuppression in heart or lung transplantation and demonstrates equivalent if not improved prophylaxis of acute rejection, and more recently demonstrates a potential influence on chronic rejection, particularly in lung transplant recipients. Of importance, the enhanced immunosuppressive activity of tacrolimus is achieved without increased risk of infection or malignancy. Differences in tolerability profiles and side effects between tacrolimus and cyclosporine may be used in selecting the optimal immunotherapy after thoracic transplantation. In particular, the lesser propensity of tacrolimus to cause hypertension and hyperlipidemia potentially offers decreased cardiovascular risk for heart and lung transplant recipients.
移植已发展成为终末期心脏病或肺病的一种公认治疗方法。急性排斥反应、与免疫抑制方案相关的并发症以及慢性排斥反应的发生，继续对心脏和肺移植的长期成功构成挑战。他克莫司作为肾移植和肝移植中一种重要的免疫抑制剂被广泛接受，随后人们开始研究将其作为心脏和肺移植受者的主要免疫抑制剂，要么与硫唑嘌呤联合使用，要么与新型药物霉酚酸酯或雷帕霉素联合使用。研究表明，在心脏或肺移植中，他克莫司是环孢素用于初始免疫抑制的一种有效治疗替代药物，在预防急性排斥反应方面即便没有改善至少也是等效的，并且最近显示出对慢性排斥反应有潜在影响，尤其是在肺移植受者中。重要的是，他克莫司增强的免疫抑制活性并未增加感染或恶性肿瘤的风险。他克莫司和环孢素在耐受性特征和副作用方面的差异可用于选择胸段移植后的最佳免疫疗法。特别是，他克莫司引起高血压和高脂血症的倾向较小，这可能会降低心脏和肺移植受者的心血管风险。
