Reduced incidence of severe infection after heart transplantation with low-intensity immunosuppression.

摘要: Despite advances in immunosuppressive therapy and prolonged graft patient survival, infection after heart transplantation remains problematic. From January 1987 through June 1989, 104 transplantations were performed 100 patients. Immunosuppression induction was by antilymphocyte globulin for 7 days, with oral cyclosporine introduced on stabilization of kidney function (day 3). Steroid rapidly tapered, azathioprine added only cases positive donor crossmatch or steroid-resistant rejection. No reverse isolation used. Twenty-two deaths occurred, one from sepsis. Actuarial survival at 6 months, 1 year, 2 years 85% +/- 4%, 81% 3%, 75% respectively. Fifty-four patients had 81 infections, which 21 bacterial; 83% these episodes treated. Sixty infections opportunistic (85% viral), 23% necessitated treatment. infection-free rates (all types necessitating treatment) month, 5%, Of the transplant recipients, 66% treated azathioprine; 47 (69%) an infection, whereas seven (19%) not receiving became infected (p less than 0.00001). Rejection noted patients, a median time to first episode 4 weeks. A low-intensity regimen has resulted fewer serious acceptable loss Increased surveillance is required 30 days postoperatively treatment rejection episodes.