Wahlers T, Mügge A, Oppelt P, Heublein B, Fieguth H G, Jurmann M J, Uthoff K, Haverich A, Albes J M, Foegh M
Department of Cardiothoracic Surgery, Hannover Medical School, Germany.
J Heart Lung Transplant. 1995 Jan-Feb;14(1 Pt 1):143-50.
The underlying mechanism of accelerated coronary vasculopathy in cardiac allografts still remains unclear. Our hypothesis was that inhibition of smooth muscle cell proliferation with the somatostatine analogue Angiopeptin may reduce vasculopathy.
Fifty-four patients received Angiopeptin injections (1500 micrograms x three times daily subcutaneously) for 21 days after the operation and three additional injections with every rejection treatment. Angiography was performed yearly, and data were compared with a matched historic control group.
Actuarial survival was 85% at 1 year and 80% at 2 years, comparable with our results in general (80%/77%). Forty-six long-term survivors could be followed by coronary angiography. At 1 year, vasculopathy was assessed in nine patients (17%). Of the 18 patients investigated at 2 years thus far, an additional three patients were found to have vasculopathy. In the control group vasculopathy was comparable, being 13% after 1 year and 20% after 2 years. A significantly lower incidence of rejections and lower creatinine values were found in the study group within the entire observation period (p < 0.05).
We conclude that Angiopeptin treatment appears to be safe without significant side effects; it may reduce the number of acute rejections, at least during the first year after heart transplantation. However, the results of the 2-year follow-up in the remaining patients would have to be included in assessing the effect of Angiopeptin. Long-term follow-up will be necessary to decide whether Angiopeptin will be helpful in reducing the incidence of transplant vasculopathy.
心脏移植后冠状动脉血管病变加速的潜在机制仍不清楚。我们的假设是，使用生长抑素类似物血管肽抑制平滑肌细胞增殖可能会减少血管病变。
54例患者在术后接受血管肽注射（1500微克，每日皮下注射3次），共21天，每次发生排斥反应时额外注射3次。每年进行血管造影，并将数据与配对的历史对照组进行比较。
1年时的实际生存率为85%，2年时为80%，与我们总体结果（80%/77%）相当。46例长期存活者可进行冠状动脉造影随访。1年时，9例患者（17%）被评估有血管病变。在迄今为止2年时接受调查的18例患者中，又有3例被发现有血管病变。对照组的血管病变情况与之相当，1年后为13%，2年后为20%。在整个观察期内，研究组的排斥反应发生率显著较低，肌酐值也较低（p<0.05）。
我们得出结论，血管肽治疗似乎是安全的，没有明显副作用；它可能会减少急性排斥反应的次数，至少在心脏移植后的第一年。然而，在评估血管肽的效果时，必须纳入其余患者2年随访的结果。需要进行长期随访以确定血管肽是否有助于降低移植血管病变的发生率。
