Plasmapheresis for Acute Humoral Rejection in Heart Transplant Patients

從1995年3月至2000年10月，台大醫院共有5個心臟移植病人因為急性體液性排斥接受血漿置換術治療。體液性排斥之診斷，有 3 例是心肌切片發現，有2例是心臟超音波異常及臨床症狀而診斷。這5例心肌切片的病理檢查，有3例有免疫螢光染色局部 lgG、IgM、C3 或 HLA-DR 抗原之沈澱，有2例組織問質水腫。這些病人接受連續 4 至 6 天的血漿置換術治療，其中第三例病患因持續受損的心臟功能，接受了三個療程的血漿置換術治療。其中有2例需要機械性循環輔助，做完血漿置換術治療及輔助的拯救性免疫抑制治療後，全部病患都可移除機械性循環輔助及強心劑治療；且追蹤心臟功能皆逐漸恢復，心內膜切片也無體液性排斥之證據。由此可知，針對心臟移植術後，急性體液性排斥、血循不穩定的病人，我們所使用的血漿置換術合併拯救性免疫抑制治療，確實可以消彌急性體液性排斥的威脅。

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並列摘要

Objective: We report our experience of treating acute humoral rejection with plasmapheresis and rescued immunosuppression in heart transplant recipients. Method: Between March 1995 and October 2000, 5 heart transplant recipients received plasmapheresis for acute humoral rejection at our hospital. Acute humoral rejection was diagnosed by endomyocardial biopsy, characteristic echocardiographic findings, and clinical symptoms and signs. Endomyocardial biopsy revealed focal deposition of IgG, 1gM, C3, C4 or HLA-DR Ag by immunofluorescence study (n=3) or interstitial edema only (n=2). These patients received daily plasmapheresis for 4 to 6 days in each treatment course. The third case received 3 courses of plasmapheresis because of persistently deteriorated myocardial contractility. During the course of acute humoral rejection, two cases needed mechanical circulatory support in addition to catecholamine infusion. Results: After plasmapheresis and concurrent rescue immunosuppression, all 5 patients could be weaned from catecholamine and mechanical circulatory support and cardiac function recovered well. No recurrence of humoral rejection was noted in the follow-up. Conclusion: Plasmapheresis with concurrent rescue immunosuppression is an effective treatment for those heart transplantation patients who suffered from acute humoral rejection complicated by unstable hemodynamics.

並列關鍵字

heart transplantation ； plasmapheresis ； humoral rejection

國際替代計量

Plasmapheresis for Acute Humoral Rejection in Heart Transplant Patients

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