南方医科大学学报 ›› 2004, Vol. 24 ›› Issue (02): 126-128,147.

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赛尼哌结合抗胸腺细胞球蛋白免疫诱导在心脏移植中应用的临床经验(附8例报告)

黄雪珊, 陈道中, 陈良万, 李增棋, 廖崇先   

  1. 福建医科大学附属协和医院心外科/福建省胸心外科研究所, 福建, 福州, 350001
  • 出版日期:2004-02-20 发布日期:2004-02-20
  • 基金资助:
    作者简介:HUANG Xue-shan (1973-),MD,attending surgeon,Tel:+86-0591-3344034,E-mail:drhxs@163.com
    通讯作者:LIAO Chong-xian,medical professor,specialized in heart transplantation,Tel:+86-0591-3344034,E-mail:Drliao@pub2.fz.fj.cn

Immunosuppression induction with daclizumab and antithymocyte globulin in cardiac transplantation: clinical experience with 8 cases

HUANG Xue-shan, CHEN Dao-zhong, CHEN Liang-wan, LI Zeng-qi, LIAO Chong-xian   

  1. 福建医科大学附属协和医院心外科/福建省胸心外科研究所, 福建, 福州, 350001
  • Online:2004-02-20 Published:2004-02-20

摘要: 目的 总结本组8例心脏移植受者应用免疫诱导方案治疗的临床经验。方法 8例终末期扩张型心肌病患者接受同种异体原位心脏移植术,免疫诱导采用术前12 h内及术后第14天2剂赛尼哌1.0 mg/kg(抗白介素-2受体抗体)结合术后前5 d 5剂抗胸腺细胞球蛋白(ATG)100 mg/d的方法,免疫抑制维持治疗采用环孢素A(或他克莫司)+骁悉(或硫唑嘌呤)+泼尼松三联方案。结果 全组无死亡,移植后早期心内膜心肌活检无明显急性排斥反应,无移植物功能不全,无明显急性肾功能不全;3例发生机会性感染,1例远期发生急性排斥反应。结论 心脏移植围术期采用2剂赛尼哌结合5剂ATG进行免疫诱导治疗方案能有效预防移植心脏急性排斥反应和减少器官功能损害,但可能增加感染的发生率。

Abstract: Objective To review the clinical experience of immunosuppression induction therapy to prevent acute rejection in 8 patients with cardiac transplant. Methods Between June, 2000 and May, 2002, 8 patients with end-stage dilated cardiomyo-pathy undergoing orthotopic cardiac transplantation received induction therapy with two-dose daclizumab (1.0 mg/kg), given intravenously within 12 h before cardiac-transplantation surgery and two weeks thereafter, and with an initial 5-day course of intravenous antithymocyte globulin (100 mg/d) following transplantation. Cyclosporine or tacrolimus, mycophenolate mofetil or azathioprine, and prednisolone were applied for immunosuppression maintenance. Results No death occurred during the follow-up. Routine endomyocardial biopsies in all cases performed in the early stage detected only mild rejection, and no acute allograft or renal dysfunction was found. Three patients developed opportunistic infection, and only one had late acute rejection in the 14th post-transplantation month. Conclusions Induction therapy with intravenous daclizumab and antithymo-cyte globulin is effective to prevent acute rejection and alleviate organ dysfunction in cardiac transplantation, but might increase the chance of infections.

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