Starzl T E, Weil R, Iwatsuki S, Klintmalm G, Schröter G P, Koep L J, Iwaki Y, Terasaki P I, Porter K A
Surg Gynecol Obstet. 1980 Jul;151(1):17-26.
Eighteen patients were treated with primary cadaveric renal transplantation using cyclosporin A therapy, and four more patients undersent cadaveric retransplantation. Eleven of the 22 recipients were conditioned with lymphoid depletion before transplantation, using thoracic duct drainage or lymphapheresis for two to eight and one-half weeks. Cyclosporin A was begun a few hours before grafting. The other 11 patients were pretreated with cyclosporin A for from one day to 18 days. After transplantation, the majority of patients in both subgroups of 11 had rejection develop, but in most, the immunologic process was readily controlled with relatively small dosages of prednisone. After follow-up periods of two to four and one-half months, one patient has died of the complications of a coronary artery reconstruction that was not related to the transplantation. Another graft was lost from rejection, and a third organ was removed because of ureteral necrosis. Nineteen of the original 22 cadaveric kidneys are functioning, including 17 of the 18 kidneys given to patients who were undergoing transplantation for the first time. The only loss in the latter group of 18 patients was in the patient who died after an open heart operation. Results of these studies have shown that cyclosporin A is a superior and safe immunosuppressive drug but that, for optimal use in cadaveric transplantation, it usually should not be given alone. Steroid therapy greatly amplified the value of cyclosporin A. Unless major delayed morbidity develops which is not obvious so far, this drug combination should permit revolutionary advances in the transplantation of all organs. Other adjuncts to the cyclosporin A-steroid combination, including lymphoid depletion techniques, will require further investigation.
18例患者接受了使用环孢素A疗法的初次尸体肾移植，另有4例患者接受了尸体再次移植。22例受者中有11例在移植前进行了淋巴细胞清除预处理，采用胸导管引流或淋巴细胞去除术，持续两至八点五周。在移植前数小时开始使用环孢素A。另外11例患者接受了1天至18天的环孢素A预处理。移植后，两个11例亚组中的大多数患者都发生了排斥反应，但在大多数情况下，免疫过程很容易用相对小剂量的泼尼松控制。在两至四个半月的随访期后，1例患者死于与移植无关的冠状动脉重建并发症。另一个移植物因排斥反应丢失，第三个器官因输尿管坏死而被切除。最初的22个尸体肾中有19个仍在发挥功能，包括给予首次接受移植患者的18个肾中的17个。后一组18例患者中唯一的移植失败发生在心脏直视手术后死亡的患者身上。这些研究结果表明，环孢素A是一种优越且安全的免疫抑制药物，但在尸体移植中要达到最佳使用效果，通常不应单独使用。类固醇疗法极大地增强了环孢素A的价值。除非出现目前尚不明显的严重延迟性发病情况，这种药物组合应能在所有器官移植方面取得革命性进展。环孢素A - 类固醇组合的其他辅助手段，包括淋巴细胞清除技术，还需要进一步研究。
