Smith S H, Kirklin J K, Geer J C, Caulfield J B, McGiffin D C
Am J Cardiol. 1987 May 1;59(12):1171-3. doi: 10.1016/0002-9149(87)90869-1.
During a 4-year experience with cardiac transplantation, 33 hearts were obtained by autopsy or surgical resection for retransplantation. Arteritis was a feature common to all rejected hearts (14 of 14), but was absent in explanted hearts without rejection (0 of 19) (p = 0.001). Monitoring of acute cardiac rejection by endomyocardial biopsy (863 biopsies) was also reviewed, with special reference to the incidence of arteritis. Among the 16 patients with arteritis on 1 or more biopsies, 44% (7 patients, confidence limits 29 to 60%) suffered fatal rejection or underwent retransplantation because of irreversible rejection. Arteritis was seen in the small vessels obtained by endomyocardial biopsy in 4 of 5 persons who underwent biopsy within 3 days of death or retransplantation due to rejection and on none of the 6 persons who underwent biopsy within 3 days of death or retransplantation for causes other than rejection. Thus, arteritis is an important indicator for severe acute rejection, and although often reversible, may identify patients at higher risk for fatal rejection. Arteritis occurred in transplanted hearts subjected to varying combinations of cyclosporine, azathioprine and steroid therapy and could not be correlated with any drug regimen.
在心脏移植的4年经验中，33颗心脏通过尸检或手术切除获得用于再次移植。动脉炎是所有被排斥心脏（14颗中的14颗）的共同特征，但在未发生排斥的取出心脏中不存在（19颗中的0颗）（p = 0.001）。还回顾了通过心内膜心肌活检监测急性心脏排斥反应（863次活检），特别提及动脉炎的发生率。在1次或多次活检中出现动脉炎的16例患者中，44%（7例，置信区间29%至60%）因不可逆转的排斥反应而发生致命性排斥或接受再次移植。在因排斥反应死亡或再次移植前3天内接受活检的5人中，有4人的心内膜心肌活检获得的小血管中可见动脉炎，而在因非排斥原因死亡或再次移植前3天内接受活检的6人中均未见到动脉炎。因此，动脉炎是严重急性排斥反应的重要指标，虽然通常是可逆的，但可能识别出致命性排斥反应风险较高的患者。动脉炎发生在接受环孢素、硫唑嘌呤和类固醇疗法不同组合治疗的移植心脏中，且与任何药物治疗方案均无关联。
