Intravenous pulse administration of cyclophosphamide is an effective and safe treatment for sensitized cardiac allograft recipients
Intravenous pulse administration of cyclophosphamide is an effective and safe treatment for sensitized cardiac allograft recipients
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DOI：
10.1161/hc1002.105128
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发表时间：
2002-03-12
期刊：
影响因子：
37.8
通讯作者：
Edwards, N
中科院分区：
文献类型：
--
作者：
Itescu, S;Burke, E;Edwards, N
背景：心脏移植受者对HLA异体抗原具有敏感性的比例正在增加，敏感性延长了获得供体的时间，并且由于细胞排斥的风险增加，预示着较差的长期同种异体移植存活率。我们研究了环磷酰胺脉冲治疗在致敏的异体心脏移植受者中的效果。方法和结果：对88例有致敏风险的心脏移植受者和26例在移植前静脉注射环磷酰胺脉冲治疗和静脉注射免疫球蛋白致敏的心脏移植受者进行了移植前和移植后的结果进行了比较，移植后作为环孢素为基础的三联免疫抑制方案的一部分，预形成的I-G抗hla抗体预测移植持续时间更长，细胞排斥反应更早。累计排斥频率高2.7倍（P=0.002）。在移植前，环磷酰胺将等待时间和死亡率降低到非敏感患者的水平。后移植。环磷酰胺阻止了I-G抗hla II类抗体和白细胞介素-2受体阳性t细胞从活检部位的生长(P
Background-The proportion of cardiac transplant recipients with preexisting sensitization to HLA alloantigens has be-ell increasing, Sensitization prolongs duration to obtaining a donor and predicts poorer long-term allograft survival because of increased risk of cellular rejections. We investigated the effect of cyclophosphamide pulse therapy in sensitized cardiac allograft recipients.Methods and Results-Pretransplant and posttransplant outcomes were compared between 88 cardiac allograft recipients at risk for sensitization and 26 sensitized recipients treated with intravenous cyclophosphamide pulse therapy together with intravenous immune globulin before transplant and as part of a cyclosporine-based triple immunosuppressive regimen after transplant, Preformed I-G anti-HLA antibodies predicted longer duration to transplantation, earlier cellular rejection. and 2.7-fold higher cumulative rejection frequency (P=0.002). Before transplant, cyclophosphamide reduced waiting time and mortality to levels in nonsensitized patients. After transplant. cyclophosphamide prevented induction of I-G anti-HLA class II antibodies and interleukin-2 receptor-positive T-cell outgrowth from biopsy sites (both P