O'Connell J B, Dec G W, Goldenberg I F, Starling R C, Mudge G H, Augustine S M, Costanzo-Nordin M R, Hess M L, Hosenpud J D, Icenogle T B
University of Utah, Salt Lake City.
J Heart Transplant. 1990 Jul-Aug;9(4):351-5; discussion 355-6.
To determine whether the heart-specific immunoreactivity associated with active myocarditis affects outcome after heart transplantation, we retrospectively analyzed the outcome of 12 patients with active lymphocytic myocarditis in their explanted native hearts identified by the Registry of the International Society for Heart Transplantation. The patients were 38 +/- 10 years of age and predominantly female (75%). In nine patients (75%), endomyocardial biopsy showed active myocarditis before transplant; eight of these patients also received immunosuppression before transplant. Recipient hemodynamic study before transplantation demonstrated an ejection fraction of 0.18 +/- 0.06, cardiac index of 1.7 +/- 0.4 L/min/m2, pulmonary artery pressure of 41 +/- 6/23 +/- 6 mm Hg, and mean pulmonary capillary wedge pressure of 30 +/- 5 mm Hg. Left ventricular end-diastolic dimension by echocardiography was 6.0 +/- 1.4 cm. Four of the patients were dependent on intravenous inotropes, and six required mechanical assistance. Over a 36-month follow-up period, 2.9 +/- 2.4 episodes of rejection occurred per patient. Sixty percent of the first episodes occurred within 2 weeks of transplantation. These patients experienced a 2.2 +/- 1.1-fold increase in rejection compared with institutional average rejection rates. Survival was significantly shorter than that of age-matched or female control subjects. This study is limited by its retrospective nature and the unusual pretransplant characteristics of the subjects. It indicates that active myocarditis may predispose patients to early severe rejection and a high mortality rate after heart transplantation.
为了确定与活动性心肌炎相关的心脏特异性免疫反应性是否会影响心脏移植后的预后，我们回顾性分析了国际心脏移植学会登记处确定的12例移植前原位心脏患有活动性淋巴细胞性心肌炎患者的预后。患者年龄为38±10岁，以女性为主（75%）。9例患者（75%）在移植前心内膜心肌活检显示有活动性心肌炎；其中8例患者在移植前也接受了免疫抑制治疗。移植前受者血流动力学研究显示射血分数为0.18±0.06，心脏指数为1.7±0.4L/min/m²，肺动脉压为41±6/23±6mmHg，平均肺毛细血管楔压为30±5mmHg。超声心动图显示左心室舒张末期内径为6.0±1.4cm。4例患者依赖静脉注射正性肌力药物，6例需要机械辅助。在36个月的随访期内，每位患者发生2.9±2.4次排斥反应。60%的首次排斥反应发生在移植后2周内。与机构平均排斥率相比，这些患者的排斥反应增加了2.2±1.1倍。生存率明显低于年龄匹配或女性对照受试者。本研究受其回顾性性质和研究对象不寻常的移植前特征所限。它表明活动性心肌炎可能使患者在心脏移植后易发生早期严重排斥反应和高死亡率。
