Newark Beth Israel Medical Center, 201 Lyons Avenue, L-4, Transplant Center, Newark, NJ 07112, USA.
Nat Rev Cardiol. 2013 Jul;10(7):422-7. doi: 10.1038/nrcardio.2013.63. Epub 2013 Apr 30.
Heart transplantation has evolved into the treatment of choice for eligible patients with end-stage heart failure. Effective immunosuppression is critical to the success of this treatment, with the modern era beginning with the advent of cyclosporin A in the 1980s. In this Perspectives article, the major prospective, randomized trials of immunosuppression after heart transplantation are briefly reviewed. These trials provided the setting for the 2011 TICTAC trial, in which combined immunosuppression was compared with monotherapy. The results of the study are discussed, as are the implications of these data for future research, including the importance of frameworks, the risks and benefits of changes in immunosuppression regimen, the future of funding for such research, and the selection of appropriate end points in trials of heart transplantation. The presupposed need for multidrug immunosuppression is challenged, and the potential efficacy and benefits of monotherapy are explored.
心脏移植已发展成为治疗终末期心力衰竭患者的首选方法。有效的免疫抑制对于这种治疗方法的成功至关重要，现代时代始于 20 世纪 80 年代环孢素 A 的出现。在这篇观点文章中，简要回顾了心脏移植后免疫抑制的主要前瞻性、随机试验。这些试验为 2011 年 TICTAC 试验提供了背景，该试验比较了联合免疫抑制与单药治疗。讨论了研究结果，以及这些数据对未来研究的意义，包括框架的重要性、免疫抑制方案改变的风险和益处、此类研究资金的未来以及心脏移植试验中适当终点的选择。多药物免疫抑制的假设必要性受到了挑战，并且探索了单药治疗的潜在疗效和益处。
