Dein J R, Oyer P E, Stinson E B, Starnes V A, Shumway N E
Department of Cardiovascular Surgery, Stanford University Medical Center, California.
Ann Thorac Surg. 1989 Sep;48(3):350-5. doi: 10.1016/s0003-4975(10)62855-x.
Between December 1980, when immunosuppression with cyclosporine was introduced, and May 1988, 288 patients underwent primary transplantation for end-stage cardiac disease (group TX). Fourteen patients underwent retransplantation for accelerated graft atherosclerosis (group RTXAGA), and 9 underwent retransplantation for intractable acute allograft rejection (group RTXREJ). Cumulative patient follow-up was 724 patient-years (range, 1 month to 7.5 years; mean, 2.3 years). Within the first 3 postoperative months, no differences were noted between groups for linearized rates of infection or rejection except between the rate of rejection for group TX (1.69 +/- 0.09 events/100 patient-days) and group RTXAGA (0.94 +/- 0.3 events/100 patient-days) (p less than 0.02). No significant differences existed between groups for actuarial rates of remaining rejection-free or infection-free for more than 7.5 years. No significant differences in actuarial survival existed except between group TX (81% +/- 2% at 1 year and 58% +/- 4% at 5 years) and group RTXREJ (44% +/- 17% at 1 year and 44% +/- 0% at 5 years) (p less than 0.05). We conclude that patients who undergo retransplantation for accelerated graft atherosclerosis experience a lower rate of early rejection and similar rates of infection and survival compared with patients who receive primary transplants. Cardiac retransplantation for rejection incurs rejection and infection at rates similar to those of primary procedures. However, patients who undergo retransplantation for rejection survive these complications significantly less often than do patients who receive primary transplants. This information should be considered when scarce donor hearts become available and retransplantation is contemplated.
从1980年12月开始引入环孢素进行免疫抑制，到1988年5月，288例患者因终末期心脏病接受了初次移植（TX组）。14例患者因移植血管加速动脉粥样硬化接受了再次移植（RTXAGA组），9例患者因难治性急性移植排斥反应接受了再次移植（RTXREJ组）。患者累计随访时间为724患者年（范围：1个月至7.5年；平均2.3年）。术后前3个月内，除TX组（1.69±0.09次事件/100患者日）和RTXAGA组（0.94±0.3次事件/100患者日）的排斥反应发生率存在差异（p<0.02）外，各移植组之间的感染或排斥反应线性发生率无差异。各移植组之间超过7.5年无排斥反应或无感染的精算发生率无显著差异。除TX组（1年时为81%±2%，5年时为58%±4%）和RTXREJ组（1年时为44%±17%，5年时为44%±0%）外，各移植组之间的精算生存率无显著差异（p<0.05）。我们得出结论，与接受初次移植的患者相比，因移植血管加速动脉粥样硬化接受再次移植的患者早期排斥反应发生率较低，感染率和生存率相似。因排斥反应进行心脏再次移植的排斥反应和感染发生率与初次手术相似。然而，因排斥反应接受再次移植的患者比接受初次移植的患者更难从这些并发症中存活下来。当可用的供体心脏稀缺并考虑再次移植时，应考虑这些信息。
