Griffith B P, Hardesty R L, Trento A, Bahnson H T
J Heart Transplant. 1985 Sep-Oct;4(5):489-93.
Looking over the five years of HTx experience in Pittsburgh we conclude that a reasonable success has been achieved and that the promise of Cy superiority has been realized. Although certain naivete about the likely panacea property of Cy occurred early, major adjustments in the original immunosuppressive protocol were required and included the use of rescue ATG, the measurement of Cy levels in the blood, the use of less Cy, and the perioperative avoidance of Cy. We anticipate a continued 80% one year survival with a likely survival in excess of 66% at five years. Furthermore, it is believed that the avoidance of early nephrotoxicity combined with the use of less Cy chronically will result in far fewer problems with nephrotoxicity. While we have been conservative with our immunosuppression, we have aggressively broadened the criteria for candidacy to include patients mortally ill, patients with elevated pulmonary vascular resistances, and those in their sixth decade. We believe that challenges for the future will include the development of selective immunosuppressants and coordinated networks for donor procurement so that more patients will have the opportunity for cardiac replacement.
回顾匹兹堡五年的心脏移植经验，我们得出结论：已取得了合理的成功，环孢素（Cy）的优势已得到体现。尽管早期对Cy可能具有的万灵药特性存在一定的天真认识，但仍需要对原免疫抑制方案进行重大调整，包括使用救援性抗胸腺细胞球蛋白（ATG）、测量血液中的Cy水平、减少Cy的使用以及围手术期避免使用Cy。我们预计一年生存率将持续保持在80%，五年生存率可能超过66%。此外，人们认为，避免早期肾毒性并长期减少Cy的使用，将大大减少肾毒性问题。虽然我们在免疫抑制方面较为保守，但我们积极扩大了候选标准，将重症患者、肺血管阻力升高的患者以及60多岁的患者纳入其中。我们认为，未来的挑战将包括开发选择性免疫抑制剂以及建立协调的供体获取网络，以便更多患者有机会进行心脏置换。
