McGiffin D C, Kirklin J K, Naftel D C
J Heart Transplant. 1985 Jul-Aug;4(4):396-9.
Five of 23 (22%) patients receiving cyclosporine immunosuppression following heart transplantation developed postoperative acute renal failure, whereas none of 17 patients treated with azathioprine had this complication (p = 0.05). Two pre-operative risk factors for acute renal failure in cyclosporine treated patients were identified: a serum creatinine greater than 2 mg/100 mL during the year prior to the transplantation and a need for inotropic support in the week prior to operation. A protocol of low dose cyclosporine and rabbit antithymocyte globulin was developed for patients with risk factors for acute renal failure. Among patients with one or both risk factors, five of nine receiving cyclosporine developed acute renal failure (56%) whereas of seven patients receiving the cyclosporine and rabbit antithymocyte globulin protocol, none developed acute renal failure (p = 0.02). The reduction in acute renal failure, using the cyclosporine/rabbit antithymocyte globulin protocol has been accomplished without an increase in early rejection or infection.
23例心脏移植后接受环孢素免疫抑制治疗的患者中有5例(22%)发生术后急性肾衰竭，而17例接受硫唑嘌呤治疗的患者均未出现此并发症(p = 0.05)。已确定环孢素治疗患者发生急性肾衰竭的两个术前危险因素：移植前一年血清肌酐大于2 mg/100 mL以及术前一周需要使用正性肌力药物支持。针对有急性肾衰竭危险因素的患者制定了低剂量环孢素和兔抗胸腺细胞球蛋白方案。在有一个或两个危险因素的患者中，接受环孢素治疗的9例中有5例(56%)发生急性肾衰竭，而接受环孢素和兔抗胸腺细胞球蛋白方案的7例患者均未发生急性肾衰竭(p = 0.02)。使用环孢素/兔抗胸腺细胞球蛋白方案减少急性肾衰竭的同时并未增加早期排斥反应或感染的发生率。
