Costello John P, Mohanakumar Thalachallour, Nath Dilip S
Division of Cardiovascular Surgery (Drs. Costello and Nath), Children's National Medical Center, Washington, DC 20010; and Departments of Surgery and Pathology & Immunology (Dr. Mohanakumar), Washington University School of Medicine, St. Louis, Missouri 63110.
Tex Heart Inst J. 2013;40(4):395-9.
Chronic rejection in the form of cardiac allograft vasculopathy is one of the major factors that affects long-term graft and patient survival after heart transplantation. Whereas multiple factors contribute to the development of cardiac allograft vasculopathy, immunologic mechanisms play the predominant role in the chronic rejection process, because both alloimmune and autoimmune responses are causal factors. In addition, many nonimmune donor and recipient factors also affect the development of cardiac allograft vasculopathy, including hyperlipidemia, cytomegalovirus infection, baseline coronary artery disease, and the mechanism of brain death in the donor. Modern immunosuppression maintenance therapies have the potential to limit the development of cardiac allograft vasculopathy in the long term. Further research initiatives are needed to identify patient-specific immunosuppressive drug regimens and to elucidate factors that contribute to the chronic rejection of cardiac transplant allografts.
心脏移植血管病变形式的慢性排斥反应是影响心脏移植后移植物长期存活和患者长期生存的主要因素之一。虽然多种因素促成了心脏移植血管病变的发展，但免疫机制在慢性排斥反应过程中起主要作用，因为同种免疫和自身免疫反应都是致病因素。此外，许多非免疫性供体和受体因素也影响心脏移植血管病变的发展，包括高脂血症、巨细胞病毒感染、基线冠状动脉疾病以及供体脑死亡机制。现代免疫抑制维持疗法有可能长期限制心脏移植血管病变的发展。需要进一步开展研究项目，以确定针对患者的免疫抑制药物方案，并阐明促成心脏移植异体移植物慢性排斥反应的因素。
