Andreone P A, Olivari M T, Elick B, Arentzen C E, Sibley R K, Bolman R M, Simmons R L, Ring W S
J Heart Transplant. 1986 Jan-Feb;5(1):13-9.
Infection remains the major cause of mortality and is a significant source of morbidity following heart transplantation. Between March 1978 and March 1986, 62 orthotopic heart transplants were performed at the University of Minnesota. There were 56 clinically significant infectious episodes in 31 of the 58 patients surviving the perioperative period. The era I (1978-1982) experience with antilymphocyte globulin, prednisone, and azathioprine and the era II (1982-1983) experience with high-dose cyclosporine and prednisone were associated with a high incidence of cytomegalovirus and fungal infections. The conversion to low-dose triple-drug immunosuppression with cyclosporine, prednisone, and azathioprine in 1983 (era III) has markedly reduced infectious deaths and altered the spectrum of clinical infection by decreasing serious fungal and cytomegalovirus infections. This protocol has also significantly reduced the incidence of rejection. The reduction of infection and rejection complications with triple-drug immunosuppression has led to improved patient survival of 94% at 1 year and 87% at 2 years.
感染仍然是心脏移植后死亡的主要原因，也是发病的重要根源。1978年3月至1986年3月期间，明尼苏达大学进行了62例原位心脏移植手术。在围手术期存活的58例患者中，有31例发生了56次具有临床意义的感染事件。第一阶段（1978 - 1982年）使用抗淋巴细胞球蛋白、泼尼松和硫唑嘌呤，以及第二阶段（1982 - 1983年）使用高剂量环孢素和泼尼松的经验，都与巨细胞病毒和真菌感染的高发生率相关。1983年（第三阶段）转为使用低剂量的环孢素、泼尼松和硫唑嘌呤三联免疫抑制疗法，显著降低了感染性死亡，并通过减少严重的真菌和巨细胞病毒感染改变了临床感染谱。该方案还显著降低了排斥反应的发生率。三联免疫抑制疗法减少了感染和排斥反应并发症，使患者1年生存率提高到94%，2年生存率提高到87%。
