Imakita M, Tazelaar H D, Rowan R A, Masek M A, Billingham M E
Transplantation. 1987 Jun;43(6):839-42.
In order to better define long-term changes in the transplanted heart with respect to the effects of cyclosporine and the ischemic time of the donor heart, endomyocardial biopsies were examined ultrastructurally from 20 cardiac transplant recipients three years posttransplantation. The biopsies were divided into four groups of five based on the donor heart ischemic time in "on-site" versus "distantly procured" hearts and on the immunosuppression protocol: group A: "on site" donor hearts and cyclosporine-based immunosuppression; group B: "on site" donor hearts with conventional immunosuppression (azathioprine-based immunosuppression without cyclosporine); group C: distantly procured donor hearts treated with cyclosporine; and group D: distantly procured donor hearts treated with conventional immunosuppression. All four groups showed a significant increase in the average width of myocytes when compared with normal myocardium, (group A, P less than 0.05; groups B, C, D, P less than 0.01). Also, there was a significant difference between the average widths of myocytes from on-site donor hearts and distantly procured donor hearts (P less than 0.04). There was no significant difference between the average myocyte widths of groups treated with cyclosporine and those with conventional immunosuppression. This study shows that despite the hypertension induced by cyclosporine, myocyte hypertrophy at 3 years posttransplantation does not appear to be significantly greater than in patients treated with conventional immunosuppression. Distantly procured donor hearts have more hypertrophy. Due to the increasing evidence that cardiac hypertrophy per se may predispose to serious ventricular arrhythmias, this study supports the use of on-site as opposed to distantly procured donor hearts.
为了更明确地界定移植心脏在环孢素作用和供体心脏缺血时间方面的长期变化，对20例心脏移植受者移植三年后的心肌内膜活检标本进行了超微结构检查。根据供体心脏在“原位”与“远距离获取”心脏时的缺血时间以及免疫抑制方案，将活检标本分为四组，每组五例：A组：“原位”供体心脏并采用基于环孢素的免疫抑制；B组：“原位”供体心脏并采用传统免疫抑制（基于硫唑嘌呤的免疫抑制，无环孢素）；C组：远距离获取的供体心脏并用环孢素治疗；D组：远距离获取的供体心脏并用传统免疫抑制治疗。与正常心肌相比，所有四组的心肌细胞平均宽度均显著增加（A组，P<0.05；B、C、D组，P<0.01）。此外，原位供体心脏与远距离获取的供体心脏的心肌细胞平均宽度之间存在显著差异（P<0.04）。用环孢素治疗的组与采用传统免疫抑制治疗的组之间，心肌细胞平均宽度无显著差异。这项研究表明，尽管环孢素会引发高血压，但移植三年后的心肌细胞肥大似乎并不比采用传统免疫抑制治疗的患者明显更严重。远距离获取的供体心脏有更明显的肥大。鉴于越来越多的证据表明心脏肥大本身可能易导致严重的室性心律失常，本研究支持使用原位供体心脏而非远距离获取的供体心脏。
