Renlund D G, Gilbert E M, O'Connell J B, Gay W A, Jones K W, Burton N A, Doty D B, Karwande S V, Dewitt C W, Menlove R L, Herrick C M, Bristow M R
Division of Cardiology, University of Utah Medical Center, Salt Lake City 84132.
Am J Med. 1987 Sep;83(3):391-8. doi: 10.1016/0002-9343(87)90746-7.
The influence of age on cardiac allograft rejection was studied in 57 consecutive recipients. Twenty-one subjects were 54 years of age or older (mean, 57.7 +/- 0.6 years [+/- SEM]; range, 54 to 63 years) and 36 subjects were 52 years of age or younger (mean, 39.9 +/- 1.8 years; range, 16 to 52 years; p less than 0.001). The older recipients had fewer rejection episodes during the first four months following cardiac transplantation (0.24 +/- 0.05 episodes per month versus 0.72 +/- 0.09 episodes per month; p less than 0.001) and during the total duration of follow-up (0.20 +/- 0.03 episodes per month versus 0.40 +/- 0.07 episodes per month; p = 0.045), and experienced their first rejection episode later (50.4 +/- 4.0 days versus 27.7 +/- 8.5 days; p = 0.008). Younger age was found to add significantly as a predictor of rejection in a multivariate analysis that controlled for sex, immunosuppressive agents, cause of heart failure, and pretransplantation lymphocyte cross-match status (r = 0.64, p less than 0.05). Decreased rejection frequency occurred without a concomitant increase in the serious infection rate (67 percent in both groups). The 12-month actuarial survival was 100 percent in the older group and 94 percent in the younger group (p = NS). Decreased rejection in the older recipients is likely a manifestation of an age-associated decline in immune function and might represent an advantage in transplantation for carefully selected older patients.
对57例连续心脏移植受者研究了年龄对心脏移植排斥反应的影响。21例受试者年龄在54岁及以上（平均57.7±0.6岁[±标准误]；范围54至63岁），36例受试者年龄在52岁及以下（平均39.9±1.8岁；范围16至52岁；p<0.001）。年龄较大的受者在心脏移植后的头四个月排斥反应发作较少（每月0.24±0.05次发作vs.每月0.72±0.09次发作；p<0.001），在整个随访期间也是如此（每月0.20±0.03次发作vs.每月0.40±0.07次发作；p=0.045），且首次排斥反应发作较晚（50.4±4.0天vs.27.7±8.5天；p=0.008）。在一项控制了性别、免疫抑制剂、心力衰竭病因和移植前淋巴细胞交叉配型状态的多变量分析中，发现年龄较小是排斥反应的一个显著预测因素（r=0.64，p<0.05）。排斥反应频率降低的同时严重感染率并未增加（两组均为67%）。年龄较大组的12个月精算生存率为100%，年龄较小组为94%（p=无显著性差异）。年龄较大的受者排斥反应减少可能是免疫功能随年龄下降的一种表现，对于精心挑选的老年患者而言可能代表着移植方面的一个优势。
