Brown J W, Turrentine M W, Kesler K A, Mahomed Y, Darragh R, Evans K, Thompson L, Caldwell R
Department of Surgery, Riley Hospital for Children, Indiana University Medical Center, Indianapolis 46202-5125.
J Heart Lung Transplant. 1993 Nov-Dec;12(6 Pt 2):S265-74.
Triple-drug immunosuppression with OKT3 induction is effective rejection prophylaxis in pediatric cardiac allograft recipients. The concerns regarding prevalent lymphoproliferative disease, growth retardation, cytomegalovirus, and other opportunistic infections have not been realized. Since June 1986, 34 pediatric patients, 23 males and 11 females, (age 4 days to 15 years) have undergone orthotopic heart transplantation at our institution. Fifteen patients were less than 6 months old and 13 had type I or II hypoplastic left heart syndrome. There have been four (12%) operative and four (12%) late deaths and a survival rate of 76% after a mean follow-up of 33 months (range, 1 to 82 months). The only deaths attributed to allograft rejection occurred in two newborn recipients (2 and 10 months after surgery) who neither received maintenance steroids nor underwent routine biopsy. The only death from infection (pneumococcus) occurred 6 months after surgery in a 4-year-old patient who was not known to be asplenic. Of the 27 long-term (> 1 year) survivors, 17 (68%) had an average of two rejection episodes during the follow-up period, 10 patients (32%) have been free of graft rejection, and 26 patients (96%) have not experienced a cytomegalovirus infection despite OKT3 induction therapy. Two patients developed lymphoproliferative disease, one of whom was successfully treated by transient reduction of immunosuppression. The other patient died 13 months after transplantation of a lymphoma of the central nervous system. All survivors have demonstrated satisfactory increases in mean height and weight.(ABSTRACT TRUNCATED AT 250 WORDS)
采用OKT3诱导的三联免疫抑制疗法对小儿心脏移植受者预防排斥反应有效。此前人们担忧的常见淋巴增殖性疾病、生长发育迟缓、巨细胞病毒感染及其他机会性感染并未出现。自1986年6月以来，34例小儿患者（23例男性，11例女性，年龄4天至15岁）在我院接受了原位心脏移植。15例患者年龄小于6个月，13例患有I型或II型左心发育不全综合征。共有4例（12%）手术死亡和4例（12%）晚期死亡，平均随访33个月（范围1至82个月）后生存率为76%。唯一因移植排斥导致的死亡发生在2例新生儿受者（术后2个月和10个月），他们既未接受维持性类固醇治疗，也未进行常规活检。唯一因感染（肺炎球菌）导致的死亡发生在1例4岁患者术后6个月，该患者此前未知无脾。在27例长期（>1年）存活者中，17例（68%）在随访期间平均发生2次排斥反应，10例患者（32%）未发生移植排斥，26例患者（96%）尽管接受了OKT3诱导治疗但未发生巨细胞病毒感染。2例患者发生淋巴增殖性疾病，其中1例通过短暂减少免疫抑制成功治疗。另1例患者在移植后13个月死于中枢神经系统淋巴瘤。所有存活者的平均身高和体重均有令人满意的增长。（摘要截选至250词）
