Rhenman B, Rhenman M J, Icenogle T B, Vasu M A, Sethi G K, Rosado L J, Williams R, Copeland J
Cardiovascular and Thoracic Surgery, University of Arizona, Tucson 85724.
J Thorac Cardiovasc Surg. 1989 Nov;98(5 Pt 2):922-7.
Since November 1985, cardiopulmonary transplantation has been performed at the University of Arizona heart transplant program. Seven patients, five women and two men, have undergone heart-lung transplantation. Five patients had primary pulmonary hypertension, and two patients had Eisenmenger's complex. The mean age was 31 years (range, 17 to 43 years). Average follow-up was 15 months (range, 3 to 34 months), with a total of 115 patient-months. There have been no operative or late deaths. Immunosuppression consisted of rabbit antithymocyte globulin, cyclosporine (Cyclosporin A), azathioprine, methylprednisolone, and prednisone. Our first five patients were aggressively diagnosed and treated for rejection by endomyocardial biopsy, with each patient having one or several treatments for acute rejection. These five patients had one or several episodes of severe infection, particularly cytomegalovirus. In our last two patients we omitted routine heart biopsies. Only those rejection episodes diagnosed by chest x-ray films are considered significant. Our last two patients have not been treated for acute rejection and have had no infections. Presently our immunologic surveillance consists only of careful clinical examination and frequent chest x-ray films. Any changes in the patient's condition are aggressively investigated, searching for infection or rejection. Two patients have been used as domino donors of their native heart.
自1985年11月以来，亚利桑那大学心脏移植项目已开展心肺移植手术。7例患者接受了心肺移植，其中5例为女性，2例为男性。5例患者患有原发性肺动脉高压，2例患者患有艾森曼格综合征。平均年龄为31岁（范围17至43岁）。平均随访时间为15个月（范围3至34个月），总计115个患者月。无手术死亡或晚期死亡病例。免疫抑制方案包括兔抗胸腺细胞球蛋白、环孢素（环孢菌素A）、硫唑嘌呤、甲泼尼龙和泼尼松。我们的前5例患者通过心内膜心肌活检积极诊断和治疗排斥反应，每位患者均接受了一次或多次急性排斥反应治疗。这5例患者发生了一次或多次严重感染，尤其是巨细胞病毒感染。在我们的最后2例患者中，我们省略了常规心脏活检。仅将胸部X光片诊断出的排斥反应发作视为有意义。我们的最后2例患者未接受急性排斥反应治疗，也未发生感染。目前，我们的免疫监测仅包括仔细的临床检查和频繁的胸部X光片检查。对患者病情的任何变化都进行积极调查，以寻找感染或排斥反应。有2例患者被用作其自身心脏的多米诺供体。
