Miller L W
Department of Internal Medicine, St. Louis University Medical Center, Mo. 63110.
J Heart Transplant. 1990 May-Jun;9(3 Pt 2):283-7.
The treatment of cardiac allograft rejection remains complex and is influenced by a number of factors, including hemodynamic compromise, severity of biopsy grade, time after transplantation, gender, and local institutional bias. This article reports the response of 43 rejection episodes in 67 patients who underwent orthotopic heart transplantation in a 3-year period and who were treated with triple-drug immunosuppression only. Eighty-eight percent (38 of 43) of the rejection episodes were treated initially with one course (3 gm) of intravenous methylprednisolone, and 82% (31 of 38) responded. Another 7% responded to a second course of intravenous corticosteroids, and the remaining 11% of the episodes eventually required the use of antilymphoblast globulin for resolution. Twelve percent of the rejections (n = 5) were initially treated with antilymphoblast globulin, and three responded. The response of cardiac allograft rejection to intravenous corticosteroids is greater than 85%, and this should be the initial treatment in most cases of rejection. The role of advanced biopsy grade, dose of corticosteroids used, and complications resulting from this form of therapy are discussed.
心脏移植排斥反应的治疗仍然很复杂，并且受到多种因素的影响，包括血流动力学损害、活检分级的严重程度、移植后的时间、性别以及当地机构的偏好。本文报告了67例在3年期间接受原位心脏移植且仅接受三联药物免疫抑制治疗的患者中43次排斥反应的治疗情况。88%（43例中的38例）的排斥反应最初采用一个疗程（3克）的静脉注射甲基泼尼松龙进行治疗，其中82%（38例中的31例）有反应。另外7%对第二个疗程的静脉注射皮质类固醇有反应，其余11%的排斥反应最终需要使用抗淋巴细胞球蛋白来解决。12%的排斥反应（n = 5）最初采用抗淋巴细胞球蛋白治疗，其中3例有反应。心脏移植排斥反应对静脉注射皮质类固醇的反应率超过85%，在大多数排斥反应病例中这应作为初始治疗方法。文中还讨论了高级活检分级的作用、所用皮质类固醇的剂量以及这种治疗方式引起的并发症。
