Hunt S A
Department of Cardiology, Stanford University Medical Center, Palo Alto, California 94305.
Cardiovasc Drugs Ther. 1988 Dec;2(5):687-91. doi: 10.1007/BF00054210.
Drug or pharmacologic management of patients with cardiac allografts is an area of clinical cardiology that is quite different from most pharmacological management involved in caring for patients with cardiac disease. In transplant patients one is dealing with a heart that is not stunned, ischemic, infarcted, hypertrophied, dilated, or in any way weak or structurally abnormal. The patient has a perfectly healthy heart, usually chronologically younger than the patient, the only flaw of which is its antigenic dissimilarity from tissue of the patient. This dissimilarity, of course, leads to the need to suppress the normal immune response and make the patient at least relatively immunologically tolerant of his or her solid organ allograft. Problems inherent in the induction and maintenance of immune tolerance in cardiac allograft patients are no different than those encountered in the more widely practiced field of renal transplantation. The major obvious difference is that of the more disastrous consequence of graft "loss" in cardiac transplant recipients since no cardiac equivalent of chronic hemodialysis exists to be resorted to. Thus, immunosuppressive regimens used in cardiac transplant programs tend to err (if they err) on the side of heavier suppression and accept the consequences of this choice.
心脏移植患者的药物或药理学管理是临床心脏病学的一个领域，与大多数治疗心脏病患者的药理学管理有很大不同。在移植患者中，所处理的心脏没有受到休克、缺血、梗死、肥大、扩张，或以任何方式虚弱或结构异常。患者有一颗完全健康的心脏，通常在年龄上比患者年轻，其唯一的缺陷是与患者组织的抗原不同。当然，这种差异导致需要抑制正常的免疫反应，并使患者至少相对免疫耐受其实体器官移植。心脏移植患者诱导和维持免疫耐受所固有的问题与肾移植这个更广泛实践领域中遇到的问题没有不同。主要的明显区别在于心脏移植受者移植“丢失”的后果更具灾难性，因为没有相当于慢性血液透析的心脏替代方法可供采用。因此，心脏移植项目中使用的免疫抑制方案往往（如果有偏差的话）倾向于更强烈的抑制，并接受这种选择的后果。
