Katz M R, Barnhart G R, Szentpetery S, Rider S, Thompson J A, Hess M, Hastillo A, Lower R R
Cardiac Transplantation Program, Medical College of Virginia, Richmond 23298.
J Heart Transplant. 1987 Sep-Oct;6(5):293-7.
To determine the necessity for maintenance dosages of prednisone in the management of heart transplant patients, a retrospective study was made of 86 patients undergoing orthotopic heart transplantation and two patients having heart-lung transplantation from June 1985 through October 1986. Group 1 (n = 52) had maintenance immunosuppressive therapy that included cyclosporine, azathioprine, and prednisone. Group 2 (n = 36) received only cyclosporine and azathioprine with no maintenance dosage of steroids. Data were analyzed for frequency of rejections, infections, noninfectious complications, and mortality. The rate of rejection was 1.44 episodes per patient in group 1 and 1.58 episodes per patient in group 2. Twenty of 52 patients (38%) in group 1 had no rejection compared with 12 of 36 patients (33%) in group 2 (p = not significant [NS]). One or more infections occurred in 30 patients (58%) in group 1, whereas only 12 patients (33%) in group 2 had infections (p less than 0.05). Noninfectious complication rates were noted to be similar in both groups (27% versus 25%, p = not significant). There were five deaths in group 1: three from infections, one from rejection, and one from trauma. There were three deaths in group 2: two from infection and one from rejection. Although 14 patients in group 2 eventually were placed on low-dosage steroid maintenance, the remaining 22 patients (61%) never received maintenance dosages of steroids. We conclude that some patients can be successfully managed without maintenance dosages of steroids after heart transplantation. Such patients do not appear to have an increased risk of rejection and may have a reduced rate of infection.(ABSTRACT TRUNCATED AT 250 WORDS)
为确定泼尼松维持剂量在心脏移植患者管理中的必要性，对1985年6月至1986年10月期间接受原位心脏移植的86例患者和2例心肺移植患者进行了一项回顾性研究。第1组（n = 52）接受包括环孢素、硫唑嘌呤和泼尼松在内的维持免疫抑制治疗。第2组（n = 36）仅接受环孢素和硫唑嘌呤，不使用类固醇维持剂量。分析了排斥反应、感染、非感染性并发症和死亡率的数据。第1组患者的排斥反应发生率为每人1.44次发作，第2组为每人1.58次发作。第1组52例患者中有20例（38%）未发生排斥反应，而第2组36例患者中有12例（33%）未发生排斥反应（p =无显著性差异[NS]）。第1组30例患者（58%）发生了一次或多次感染，而第2组只有12例患者（33%）发生感染（p<0.05）。两组的非感染性并发症发生率相似（27%对25%，p =无显著性差异）。第1组有5例死亡：3例死于感染，1例死于排斥反应，1例死于创伤。第2组有3例死亡：2例死于感染，1例死于排斥反应。虽然第2组中有14例患者最终接受了低剂量类固醇维持治疗，但其余22例患者（61%）从未接受过类固醇维持剂量治疗。我们得出结论，心脏移植后一些患者不使用类固醇维持剂量也能成功管理。这类患者发生排斥反应的风险似乎没有增加，感染率可能会降低。（摘要截短于250字）
