Leech S H, Lopez-Cepero M, LeFor W M, DiChiara L, Weston M, Furukawa S, Macha M, Singhal A, Wald J W, Nikolaidis L A, McClurken J B, Bove A A
Department of Cardiology, Temple University Hospital and School of Medicine, Philadelphia, PA 19140, USA.
Clin Transplant. 2006 Jul-Aug;20(4):476-84. doi: 10.1111/j.1399-0012.2006.00509.x.
Previously, we reported that the combination of plasmapheresis (PP) and intravenous immunoglobulin (IVIg) allow sensitized patients to undergo orthotopic heart transplantation (OHT), even across a positive crossmatch. In the current study, the effect of that combination, PP+IVIg, on survival of a larger group of such recipients is investigated. The latter group (I) consisted of 35 sensitized patients who received PP+IVIG together with standard immunosuppressive drugs. Rejection was seen in 11 patients, findings strongly suggestive of a vascular (humoral) being identified in five of those cases. Four deaths occurred, two of them in the immediate post-operative period, one after almost six months, and one after almost two yr post-OHT. Follow-up range 4.5 months to 7.8 yr post-OHT (average=1.1 yr). Patient survival was analyzed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given standard immunosuppressive drugs only (N=276) showed enhanced survival of group I (p=0.0414 by log-rank test). We conclude that the combination of PP and IVIG (i) is associated with declines in T- and B-percent-reactive antibody and in crossmatch positivity, and (ii) is very useful in the management of the sensitized cardiac patient undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch.
此前，我们报道过血浆置换（PP）与静脉注射免疫球蛋白（IVIg）联合使用可使致敏患者接受原位心脏移植（OHT），甚至在交叉配血阳性的情况下也能进行。在本研究中，我们调查了这种联合治疗方案（PP + IVIg）对更多此类受者生存情况的影响。后一组（I组）由35名致敏患者组成，他们在接受标准免疫抑制药物治疗的同时还接受了PP + IVIG治疗。11名患者出现排斥反应，其中5例的检查结果强烈提示存在血管（体液）排斥反应。4例患者死亡，其中2例在术后即刻死亡，1例在术后近6个月死亡，1例在OHT术后近2年死亡。随访时间为OHT术后4.5个月至7.8年（平均 = 1.1年）。绘制Kaplan - Meier生存曲线后对患者生存率进行了分析。与仅接受标准免疫抑制药物治疗的对照OHT组（II组，N = 276）相比，I组患者的生存率有所提高（对数秩检验p = 0.0414）。我们得出结论，PP与IVIG联合使用（i）与T细胞和B细胞反应性抗体水平降低以及交叉配血阳性率降低有关，（ii）在致敏心脏患者接受OHT的治疗中非常有用，通常能使交叉配血阳性的患者成功完成移植。
