PMID- 17889193
OWN - NLM
STAT- MEDLINE
DCOM- 20071113
LR  - 20220317
IS  - 0041-1345 (Print)
IS  - 0041-1345 (Linking)
VI  - 39
IP  - 7
DP  - 2007 Sep
TI  - Late steroid withdrawal after heart transplantation and incidence of acute 
      rejection.
PG  - 2372-4
AB  - BACKGROUND: Steroid withdrawal (SW) after heart transplantation (HT) reduces 
      steroid-associated side effects, although it can increase acute rejection 
      episodes (ARE). Patient selection criteria for SW and the time elapsed after HT 
      for this maneuver are controversial issues. The objective of this study was to 
      assess the safety of late SW after HT with regard to the occurrence of ARE and to 
      analyze risk factors resulting in a poor evolution. METHODS: We studied a cohort 
      of 24 patients who underwent SW late after HT. All of them had gone at least 4 
      years without any ARE. Independent variables were time after HT, general 
      recipient and donor data, risk factors for ARE, and immunosuppression. The 
      dependent variables were occurrence of ARE (proven or not proven with 
      endomyocardial biopsy) and time and severity of ARE. RESULTS: Among 24 HT 
      patients including 96% men with an overall mean age of 57 years who underwent SW, 
      the mean follow-up was 2.32 +/- 0.86 years. Six patients (25%) displayed an ARE 
      >or=2R according to the International Society for Heart and Lung Transplantation 
      (ISHLT) at 5 +/- 3 months after SW. There were no deaths. Time from the last 
      rejection episode to SW was 6.6 +/- 2 years. All ARE were treated with steroid 
      boluses (mean total dose 1583 +/- 1044 mg). Among the HT patients with ARE, 5 
      (85%) had never experienced ARE after HT. Upon long-term follow-up, there were 2 
      deaths: 1 sudden death at 30 months after SW and 1 due to allograft vasculopathy 
      at 20 months post-SW. Currently 92% are New York Heart Association (NYHA) 
      functional class I with a mean left ventricular ejection fraction of 67% +/- 10%. 
      CONCLUSIONS: In our series of HT with late SW after HT (even among an HT 
      population with a low risk of rejection), there was a 25% rate of ARE. This study 
      did not allow us to identify risk factors for ARE after SW. We believe that based 
      upon these observations SW should be implemented with caution.
FAU - Crespo-Leiro, M G
AU  - Crespo-Leiro MG
AD  - Area del Corazon, Complejo Hospitalario Juan Canalejo, La Coruna, Spain. 
      mcrelei@canalejo.org
FAU - Paniagua, M J
AU  - Paniagua MJ
FAU - Franco, R
AU  - Franco R
FAU - Marzoa, R
AU  - Marzoa R
FAU - Grille, Z
AU  - Grille Z
FAU - Naya, C
AU  - Naya C
FAU - Barge, E
AU  - Barge E
FAU - Rios, R
AU  - Rios R
FAU - Rodriguez, J A
AU  - Rodriguez JA
FAU - Calvino, R
AU  - Calvino R
FAU - Cuenca, J J
AU  - Cuenca JJ
FAU - Castro-Beiras, A
AU  - Castro-Beiras A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adrenal Cortex Hormones/*administration & dosage
MH  - Drug Administration Schedule
MH  - Female
MH  - Graft Rejection/*epidemiology/immunology/prevention & control
MH  - Heart Transplantation/immunology/*physiology
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Retrospective Studies
MH  - Time Factors
EDAT- 2007/09/25 09:00
MHDA- 2007/11/14 09:00
CRDT- 2007/09/25 09:00
PHST- 2007/09/25 09:00 [pubmed]
PHST- 2007/11/14 09:00 [medline]
PHST- 2007/09/25 09:00 [entrez]
AID - S0041-1345(07)00899-8 [pii]
AID - 10.1016/j.transproceed.2007.07.065 [doi]
PST - ppublish
SO  - Transplant Proc. 2007 Sep;39(7):2372-4. doi: 10.1016/j.transproceed.2007.07.065.