Chinnock R, Emery J, Larsen R, Baum M, Janner D, Razzouk A, Gundry S, Nehlsen-Cannarella S, Bailey L
Department of Pediatrics, Loma Linda University Children's Hospital, Calif. 92350, USA.
J Heart Lung Transplant. 1995 Jul-Aug;14(4):726-33.
We retrospectively reviewed all pediatric heart transplant recipients at Loma Linda University Medical Center between January 1990 and September 1993 to evaluate the efficacy and safety of methotrexate when it is used for the treatment of graft rejection.
Twenty-eight of 156 patients (18%) received methotrexate therapy. The dose used for recurrent rejection was 10 mg/m2/week given every 12 hours for three doses. Rejection history, complete blood counts, liver function tests, and infectious complications were reviewed.
Eighteen patients were treated for recurrent rejection. Methotrexate was begun at a median of 115 days (13 to 1093 days). Older patients were more likely to receive methotrexate (p < 0.01). Efficacy was assessed as rejection episodes (mean +/- standard deviation) occurring in the 2 months before methotrexate administration compared with the 2 months after methotrexate administration and fell from 2.0 +/- 0.2 to 0.6 +/- 0.2 episodes (p < 0.001). The rejection rate (rejections per patient-month) fell in treated patients to a rate similar to patients who did not receive methotrexate. Two patients (11%) died while receiving methotrexate. An additional nine patients were treated for acute rejection with hemodynamic compromise, and one was treated for graft-versus-host disease. The incidence of significant infections was 50% (but no deaths were due to infection) during methotrexate therapy in all patients treated (n = 28). The minimum white blood cell count in the first month of methotrexate therapy occurred at 2 weeks (median of 2700 to 3500 x 10(6) cells/L). Only one patient had elevated transaminase levels.
Methotrexate is an effective and safe adjunct in the management of chronic pediatric cardiac graft rejection.
我们回顾性研究了1990年1月至1993年9月间在洛马林达大学医学中心接受小儿心脏移植的所有患者，以评估甲氨蝶呤用于治疗移植排斥反应的疗效和安全性。
156例患者中有28例（18%）接受了甲氨蝶呤治疗。用于复发性排斥反应的剂量为10mg/m²/周，每12小时给药一次，共三剂。回顾了排斥反应病史、全血细胞计数、肝功能检查和感染并发症情况。
18例患者接受了复发性排斥反应治疗。甲氨蝶呤开始使用的中位时间为115天（13至1093天）。年龄较大的患者更有可能接受甲氨蝶呤治疗（p<0.01）。疗效评估为甲氨蝶呤给药前2个月与给药后2个月发生的排斥反应发作次数（平均值±标准差），从2.0±0.2次降至0.6±0.2次（p<0.001）。接受治疗的患者的排斥率（每患者月的排斥次数）降至与未接受甲氨蝶呤治疗的患者相似的水平。两名患者（11%）在接受甲氨蝶呤治疗时死亡。另外9例患者因急性排斥反应伴血流动力学不稳定接受治疗，1例患者因移植物抗宿主病接受治疗。在所有接受治疗的患者（n=28）中，甲氨蝶呤治疗期间严重感染的发生率为50%（但无死亡因感染所致）。甲氨蝶呤治疗第一个月的最低白细胞计数出现在2周时（中位数为2700至3500×10⁶个细胞/L）。只有1例患者转氨酶水平升高。
甲氨蝶呤是治疗小儿慢性心脏移植排斥反应的一种有效且安全的辅助药物。
