Renlund D G, O'Connell J B, Bristow M R
Division of Cardiology, University of Utah Medical Center, Salt Lake City 84132.
Semin Thorac Cardiovasc Surg. 1990 Apr;2(2):181-8.
Immunosuppression for cardiac transplantation, as currently practiced, is based to a large extent on clinical trials that can best be characterized as single-institutional, uncontrolled, or historically controlled studies. While these non-randomized, retrospective studies clearly advanced the science and art of cardiac transplantation to the point that survival rates approaching 90% at 1 year are achievable, the specific immunosuppressive protocols used at any given institution are likely based more on the individual transplant surgeon's or physician's training and experience, than on a firm scientific basis. Thus, a significant lack of uniformity exists among transplant centers in virtually all phases of immunosuppression. More clinical and basic research efforts are needed to unify immunosuppressive strategies following cardiac transplantation. In the future, greater individualization of therapy is likely to occur and more prospectively randomized, multi-center trials are likely to be carried out, particularly in the area of early rejection prophylaxis.
目前实施的心脏移植免疫抑制疗法，在很大程度上基于一些临床试验，这些试验最适合被描述为单机构、非对照或历史对照研究。虽然这些非随机、回顾性研究确实推动了心脏移植科学与技术的发展，使一年生存率接近90%成为可能，但任何特定机构所采用的具体免疫抑制方案，可能更多地基于个体移植外科医生或内科医生的培训与经验，而非坚实的科学依据。因此，在免疫抑制的几乎所有阶段，移植中心之间都存在显著的缺乏一致性的情况。需要更多的临床和基础研究工作来统一心脏移植后的免疫抑制策略。未来，治疗可能会更加个体化，并且可能会开展更多前瞻性随机、多中心试验，特别是在早期排斥反应预防领域。
