Ma H, Hammond E H, Taylor D O, Yowell R L, Bristow M R, O'Connell J B, Renlund D G
Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, USA.
Transplantation. 1996 Jul 27;62(2):205-10. doi: 10.1097/00007890-199607270-00010.
While vascular cardiac allograft rejection increases morbidity and mortality following transplantation, factors predisposing to its development have not been completely elucidated. To evaluate the influence of the duration of early rejection prophylaxis with the murine monoclonal anti-CD3 antibody (OKT3) on the development of a repetitive histologic pattern of vascular cardiac allograft rejection, endomyocardial biopsies from 344 heart transplant recipients were prospectively evaluated. The influence of clinical characteristics was assessed. Eighty-three patients (24%) developed and 261 patients (76%) did not develop a repetitive histologic pattern of vascular cardiac allograft rejection. The vascular rejection pattern was more common in patients with a positive crossmatch (89% versus 11%, P<0.0001) and OKT3 sensitization (73% versus 27%, P<0.0001), and was positively correlated with the duration of OKT3 treatment (P<0.0001). The correlation persists even after excluding patients with a positive crossmatch or OKT3 sensitization. Patients developing a repetitive histologic pattern of vascular cardiac allograft rejection early after transplantation had decreased allograft survival (P=0.0008). The development of a repetitive histologic pattern of vascular cardiac allograft rejection is positively correlated with the duration of OKT3 treatment. Judicious use of OKT3 in early rejection prophylaxis in cardiac transplantation is warranted.
虽然心脏移植术后血管性移植物排斥反应会增加发病率和死亡率，但其发生的易感因素尚未完全阐明。为了评估用鼠单克隆抗CD3抗体（OKT3）进行早期排斥反应预防的持续时间对心脏移植血管性移植物排斥反应重复性组织学模式发生的影响，对344例心脏移植受者的心肌内膜活检进行了前瞻性评估。评估了临床特征的影响。83例患者（24%）出现了心脏移植血管性移植物排斥反应的重复性组织学模式，261例患者（76%）未出现。血管排斥模式在交叉配型阳性患者（89%对11%，P<0.0001）和OKT3致敏患者（73%对27%，P<0.0001）中更常见，并且与OKT3治疗持续时间呈正相关（P<0.0001）。即使排除交叉配型阳性或OKT3致敏的患者，这种相关性仍然存在。移植后早期出现心脏移植血管性移植物排斥反应重复性组织学模式的患者移植存活率降低（P=0.0008）。心脏移植血管性移植物排斥反应重复性组织学模式的发生与OKT3治疗持续时间呈正相关。在心脏移植早期排斥反应预防中明智地使用OKT3是有必要的。
