THE INFLUENCE OF REJECTION EPISODES ON THE DEVELOPMENT OF CORONARY-ARTERY DISEASE AFTER HEART-TRANSPLANTATION

被引：33

作者：

SCHUTZ, A

KEMKES, BM

KUGLER, C

ANGERMANN, C

SCHAD, N

RIENMULLER, R

FRITSCH, S

ANTHUBER, M

NEUMAIER, P

GOKEL, JM

机构：

[1] Department of Cardiac Surgery, University of Munich-Grosshadern, Munich

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1990年 / 4卷 / 06期

关键词：

Coronary artery disease; Early detection; Noninvasive methods; Rejection episodes;

D O I：

10.1016/1010-7940(90)90206-F

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Since 1981, 77 of 116 patients undergoing heart transplantation (HTx)have survived from 6 months to 8 years. Graft control involved a total of 871 endomyocardial biopsies (EMB) and 141 angiographies. Sixteen patients developed coronary artery disease (CAD) manifesting itself 7 – 60 monthsafter HTx (20.7%). These patients (15 male, 1 female) experienced multiple rejection episodes (RE) and more than half suffered from hypercholesterolaemia and hypertension (n = 10). A mean rejection score (Billingham grading) of > 1 (x¯ = 1.6 ± 1.1) was calculated in all patients with CAD at the time of angiography or autopsy. By contrast, the mean rejection score ranked < 1 in patients with undetectable or resolved CAD (means = 0.4 ± 0.38). This rate is not remarkably different from the rejection score in patients (n = 61) withoutCAD (x¯ = 0.2 ± 0.4). The 8 patients alive (56 ± 18 months) showed a low number of RE/year (x¯ = 1.1 ± 0.4) compared with x¯ = 1 ± 0.9 in patients without CAD. Eight patients expired within a short period (x¯ = 31 ± 26.9) and had a significantly higher number of RE/year (x¯ = 4.3 ± 2.9; P < 0.01 vs. no CAD, CAD alive). Autopsy (n = 6) andangiographic studies (n = 46) demonstrated diffuse, concentric, obliterative arterial disease in all vessels (type A) in 6 patients (RE/yr:x¯ = ± 5.5 ± 2.3), single stenoses in major coronary vessels (type B)in 7 patients and ordinary atherosclerosis (3-vessel disease) comparable to ischaemic heart disease (type C) in 3 patients. The angiographic findings of type B resolved in 6 cases. The early detection of RE and CAD was sought using noninvasive methods: echocardiography (M-mode, 2-DE), antimyosin-scintigraphy, fatty acid metabolism, radionuelide-scintigraphy and MR-imaging. The reliability of these methods was proven by EMB and angiography. Due to noninvasive assessment, well-timed successful PTCA was achieved in 3 patients. Constrictive vasculopathy resolved in 6 patients after therapy of rejection. © Springer-Verlag.

引用

页码：300 / 308

页数：9

共 37 条

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