Prieto M, Lake K D, Pritzker M R, Jorgensen C R, Arom K V, Love K R, Emery R W
Cardiothoracic Transplantation Program, Minneapolis Heart Institute, Minn. 55407.
J Heart Lung Transplant. 1991 Nov-Dec;10(6):901-11.
A group of high-risk heart transplant patients (n = 35) were treated from May 1987 through June 1990, with murine-derived monoclonal CD3 antibody (OKT3) induction therapy and steroid-free maintenance immunosuppression. This group was compared with a group of transplant patients (n = 47) who were not considered high risk and who were treated simultaneously with triple-drug immunosuppression (cyclosporine, azathioprine, and prednisone). The 1- and 3-year actuarial survival rates were similar: 97% and 91% for the OKT3 and 92% and 85% for the triple-drug immunosuppression groups, respectively. The overall incidence of rejection was equal for both groups (56%). No rejection occurred during the OKT3 course and rejection episodes occurred significantly later in patients treated with OKT3, with a mean first rejection episode of 111 +/- 104 days versus 27 +/- 21 days for the triple-drug immunosuppression group (p less than or equal to 0.05). Bacterial infections were seen more frequently (29% vs 6% of the patients treated) in the early period (less than 3 months) in the OKT3 group (p = 0.01) and were associated with the use of mechanical assistance in this group. The incidence of late infections or cytomegalovirus disease was similar for both groups. Patients treated with OKT3 and subsequent steroid-free maintenance immunosuppression had no significant posttransplantation increases of serum cholesterol levels, and hypertension was less common. Initial hospitalization was longer (p less than or equal to 0.05) in the OKT3 group (23 +/- 19 vs 13 +/- 5 days) but after the initial discharge the number of hospital days for the first year was similar for both groups (8 +/- 14 vs 9 +/- 13 days). Ventricular function at 1 year after transplantation was similar for both groups with average ejection fraction of 57% and 59% for the OKT3 and triple-drug immunosuppression groups, respectively. In conclusion, high-risk patients treated with OKT3 and steroid-free maintenance immunosuppression were managed on smaller doses of immunosuppressive drugs in the early postoperative period, and had excellent long-term survival rates. In this group of patients, rejection was delayed and the incidence of hypercholesterolemia, hypertension, and steroid-induced complications was decreased. Such a regimen offers a relatively drug-free period in the early posttransplant stages and freedom from the long-term complications of steroids.
一组高危心脏移植患者（n = 35）于1987年5月至1990年6月接受治疗，采用鼠源单克隆CD3抗体（OKT3）诱导治疗及无类固醇维持免疫抑制治疗。该组与一组非高危移植患者（n = 47）进行比较，后者同时接受三联药物免疫抑制治疗（环孢素、硫唑嘌呤和泼尼松）。1年和3年的精算生存率相似：OKT3组分别为97%和91%，三联药物免疫抑制组分别为92%和85%。两组的总体排斥发生率相等（56%）。在OKT3治疗过程中未发生排斥反应，且接受OKT3治疗的患者排斥发作明显较晚，三联药物免疫抑制组的首次排斥发作平均为27±21天，而OKT3组为111±104天（p≤0.05）。在早期（小于3个月），OKT3组细菌感染更为常见（治疗患者的29%对6%）（p = 0.01），且与该组使用机械辅助有关。两组晚期感染或巨细胞病毒疾病的发生率相似。接受OKT3及随后无类固醇维持免疫抑制治疗的患者移植后血清胆固醇水平无显著升高，高血压也较少见。OKT3组的初始住院时间较长（p≤0.05）（23±19天对13±5天），但首次出院后两组第一年的住院天数相似（8±14天对9±13天）。移植后1年两组的心室功能相似，OKT3组和三联药物免疫抑制组的平均射血分数分别为57%和59%。总之，接受OKT3及无类固醇维持免疫抑制治疗的高危患者在术后早期使用较小剂量的免疫抑制药物进行管理，且长期生存率良好。在这组患者中，排斥反应延迟，高胆固醇血症、高血压和类固醇诱导并发症的发生率降低。这种治疗方案在移植后早期提供了一个相对无药物的时期，且避免了类固醇的长期并发症。
