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首页> 外文期刊>Seminars in thoracic and cardiovascular surgery >Immunosuppression, diagnosis, and treatment of cardiac allograft rejection.
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Immunosuppression, diagnosis, and treatment of cardiac allograft rejection.

机译：心脏移植排斥反应的免疫抑制，诊断和治疗。

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The success of cardiac transplantation has been largely attributable to the development of effective immunosuppressive regimens. The calcineurin inhibitors were pivotal in reducing the frequency of acute rejection and improving early survival. Newer agents, including mycophenolate mofetil and proliferation signal inhibitors, show some promise in further reducing episodes of acute allograft rejection and also having a significant impact on reducing transplant vasculopathy. The role of cytolytic induction therapy remains unclear, although its use may be most appropriate in the high risk presensitized transplant recipient. While the endomyocardial biopsy remains the gold standard for the diagnosis of acute allograft rejection, its invasive nature makes the test suboptimal. The presence of biopsy 'negative' rejection has also led to an appreciation for the role of antibody-mediated rejection in cardiac allograft dysfunction. Effective noninvasive evaluation of allograft rejection remains the ultimate challenge. While imaging technologies have some utility because of their ease of use, more sophisticated techniques such as gene-expession analysis from peripheral blood may show the greatest promise. Management of established acute allograft rejection has significantly improved with our understanding of the immune mechanisms involved. Therapies may be targeted specifically at cellular or humoral components of the immune system.
机译：心脏移植的成功很大程度上归因于有效免疫抑制方案的发展。钙调神经磷酸酶抑制剂在减少急性排斥反应的频率和提高早期生存率方面至关重要。新型药物，包括霉酚酸酯和增殖信号抑制剂，在进一步减少急性同种异体排斥反应发作方面也显示出一定的希望，并且对减少移植性血管病也具有重要影响。溶细胞诱导疗法的作用仍不清楚，尽管它在高风险的预致敏移植接受者中最合适。尽管心内膜活检仍是诊断急性同种异体移植排斥的金标准，但其侵入性使该检测不理想。活检“阴性”排斥反应的存在还导致人们认识到抗体介导的排斥反应在心脏同种异体移植功能障碍中的作用。有效的非侵入性评估同种异体移植排斥仍然是最终的挑战。尽管成像技术因其易用性而具有一定的实用性，但更复杂的技术（例如来自外周血的基因表达分析）可能显示出最大的希望。通过我们对所涉及的免疫机制的了解，已建立的急性同种异体移植排斥反应的管理已得到显着改善。治疗可以专门针对免疫系统的细胞或体液成分。

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