Jazzar A, Fagiuoli S, Sisson S, Zuhdi N, Cooper D K
Oklahoma Transplantation Institute, Baptist Medical Center, Oklahoma City 73112, USA.
Clin Transplant. 1995 Aug;9(4):334-9.
Since 1989, the immunosuppressive regimen used in all heart transplant patients at our center has consisted of (i) cyclosporine induction therapy (pretransplant p.o. 2-6 mg/kg depending on serum creatinine level, with immediate post-transplant i.v. therapy at 1-3 mg/h until p.o. therapy alone maintains a whole blood trough level of 300 ng/ml by RIA); (ii) azathioprine (2.5 mg/kg/d i.v./p.o.); (iii) methylprednisolone i.v. for 24 h and then prednisone p.o. at 1 mg/kg/d, tapering to 0.1 mg/kg/d at 1 yr. No prophylactic cytolytic agents (ALG, OKT3) were given. One hundred consecutive patients have been followed for periods of 4-56 months (mean 27 months). The incidence of acute rejection requiring increased therapy was 24%, with only 7% requiring i.v. steroids, 2 of whom (2%) also required ALG and/or OKT3, and with 17% requiring increased oral immunosuppression alone. Mean creatinine levels (mg/dl) were 1.3 pretransplant, 1.4 on d 7, 1.5 at 30 d, and 1.8 after 2 yr. Only 1 patient required temporary hemodialysis. Survival was 98% at 30 d, 94% at 1 yr, and 92% at 2 yr. We conclude that cyclosporine induction therapy with steroids and azathioprine without any cytolytic agent results in a low incidence of acute rejection without jeopardizing renal function.
自1989年以来，我们中心所有心脏移植患者使用的免疫抑制方案包括：（i）环孢素诱导治疗（移植前口服，根据血清肌酐水平为2 - 6mg/kg，移植后立即静脉注射，速度为1 - 3mg/h，直至仅口服治疗通过放射免疫分析维持全血谷浓度为300ng/ml）；（ii）硫唑嘌呤（2.5mg/kg/d，静脉注射/口服）；（iii）静脉注射甲泼尼龙24小时，然后口服泼尼松，剂量为1mg/kg/d，1年后逐渐减至0.1mg/kg/d。未给予预防性细胞溶解剂（抗淋巴细胞球蛋白、OKT3）。连续100例患者随访了4 - 56个月（平均27个月）。需要增加治疗的急性排斥反应发生率为24%，仅7%需要静脉注射类固醇，其中2例（2%）还需要抗淋巴细胞球蛋白和/或OKT3，17%仅需要增加口服免疫抑制。移植前平均肌酐水平（mg/dl）为1.3，第7天为1.4，30天时为1.5，2年后为1.8。仅1例患者需要临时血液透析。30天时生存率为98%，1年时为94%，2年时为92%。我们得出结论，使用类固醇和硫唑嘌呤进行环孢素诱导治疗，不使用任何细胞溶解剂，可使急性排斥反应发生率较低，且不损害肾功能。
