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目的：探讨分析原位心脏移植术治疗终末期心脏病的疗效。方法回顾性分析同种异体原位心脏移植受者40例的临床资料。其中扩张型心肌病29例、缺血性心肌病6例、肥厚型心肌病4例和限制性心肌病1例。免疫抑制治疗采用环孢素＋糖皮质激素＋吗替麦考酚酯三联方案，35例受者给予抗Tac单克隆抗体或巴利昔单克隆抗体的诱导治疗。根据血药谷浓度（C0）与峰浓度（C2）调整环孢素的使用。结果术后1个月存活率95％（38／40）。1、3、5年生存率分别为90％、82．5％、77．5％。受体主要死亡原因包括右心衰竭、真菌感染及移植物衰竭。出现急性排斥反应7例，经激素冲击治疗后均逆转，排斥反应发生率17．5％。采用环孢素血药浓度C0、C2同时监测后发生排斥反应3例，发生率15％。结论心脏移植术治疗各种终末期心脏病疗效确实可靠，C0、C2同时监测可控制环孢素浓度在有效的范围内，避免早期急性排斥反应的发生。“,”Objective To summarize and analyze the clinical efficacy and experiences of orthotopic cardiac transplanta-tion for end-stage heart disease.Methods Data of 40 patients underdoing orthotopic heart transplantation in our center in the past 10 years were retrospectively reviewed.The enrollments included 29 cases of dilated cardiomyopathy,6 ca-ses of ischemic heart disease,4 cases of hypertrophic cardiomyopathy,and 1 case of restrictive cardiomyopathy.Immu-nosuppressive therapy with cyclosporine A,corticosteroid,and mycophenolate mofetile was adopted.Thirty-five pa-tients received induction therapy with Tac monoclonal antibody or basiliximab monoclonal antibody.According to trough concentration (C0)and peak concentration (C2),the dose of cyclosporine A was regulated.Results The rate of successful operation was 95% (38/40).The 1-,3-,5- year survival rate was 90%,82.5%,and 77.5%.Main causes of death were right heart failure,fungal infection,and graft failure.Acute rejection occurred in 7 cases (17.5%),and all recovered after cortieasteriod impulse therapy.Three cases were diagnosed as rejection after C0 and C2 were monitored spontaneously.Conclusion Its reliable to treat patients with end-stage heart disease with orthotopic cardiac transplantation.Monitoring C0 and C2 can control the cyclosporine concentration within the valid range and avoid occurrence of early acute rejection.