Kobashigawa J A, Stevenson L W, Brownfield E D, Moriguchi J D, Kawata N, Fandrich R, Drinkwater D C, Laks H
Division of Cardiology, UCLA School of Medicine, University of California 90024.
J Heart Lung Transplant. 1992 Mar-Apr;11(2 Pt 2):428-30.
Steroid-free maintenance immunosuppression is frequently initiated early after transplantation. There is concern that later steroid withdrawal, particularly after previous rejection, may cause more serious rejection. To determine the safety of gradual weaning from steroid maintenance, 68 patients (more than 6 months from transplantation) were weaned from 5 mg/day by decreasing the daily dose by 1 mg each month, with monthly biopsies. Asymptomatic moderate rejection occurred in 13 compliant patients. Rejection with hemodynamic compromise occurred in two patients with documented medication noncompliance, who were excluded from further analysis. Successful weaning without rejection was possible in 53 of 66 (80%) compliant patients. Compared with the rejection group, there were no differences in the number of women, previous rejection episodes, or time from transplantation. All moderate rejection episodes responded to oral steroid pulse therapy. The two serious rejections after noncompliance responded to OKT3. There were no symptoms from steroid withdrawal that required taper alteration. We conclude that regardless of previous rejection episodes, weaning from maintenance steroids can be attempted safely if guided by frequent biopsy procedures, but compliance is critical.
无类固醇维持免疫抑制治疗通常在移植后早期开始。有人担心后期停用类固醇，尤其是在先前发生排斥反应之后，可能会导致更严重的排斥反应。为了确定逐渐停用类固醇维持治疗的安全性，对68例移植后超过6个月的患者进行了研究，通过每月将每日剂量减少1mg，从5mg/天开始逐渐减量，并每月进行活检。13例依从性良好的患者发生了无症状的中度排斥反应。2例记录有用药不依从的患者发生了伴有血流动力学损害的排斥反应，这2例患者被排除在进一步分析之外。66例依从性良好的患者中有53例（80%）成功减量且未发生排斥反应。与排斥反应组相比，女性患者数量、先前排斥反应发作次数或移植后的时间均无差异。所有中度排斥反应发作均对口服类固醇冲击疗法有反应。不依从后发生的2例严重排斥反应对OKT3有反应。没有因类固醇减量而出现需要改变减量方案的症状。我们得出结论，无论先前是否发生排斥反应发作，如果在频繁活检程序的指导下，停用维持类固醇治疗可以安全尝试，但依从性至关重要。
