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Outcome after steroid withdrawal in heart transplantation.

Abstract：

BACKGROUND:There is a lack of consensus and insufficient data to assess the impact of late steroid withdrawal after heart transplantation (HTx). The aim of the study was to investigate the security and feasibility of corticosteroid withdrawal at 1 year after transplantation. METHODS AND RESULTS:Steroid withdrawal was attempted after at least 12 months of treatment in 86 HTx patients who fulfilled the criteria. At 1 and 3 months after drug discontinuation, patients underwent 2 endomyocardial biopsies (EMB). After a mean follow-up of 25 +/- 13 months, 63% of the patients remained steroid free. In 30 patients (35%) corticosteroids were reinitiated, in 15 cases because of acute rejection (7%), 5 (6%) because of worsening renal function, 5 (6%) because of malignancy, 3 (4%) because of adverse effects of immunosuppressive drugs, and 2 because of severe allograft coronary artery disease. Four patients (5%) died after drug discontinuation. There was a significant decrease in total cholesterol (198 +/- 35 to 181 +/- 38 mg/dL; P < .001) and low-density lipoprotain (LDL) cholesterol levels (113 +/- 30 to 105 +/- 30 mg/dL; P < .001). There were no differences in mortality between patients with and without corticosteroids. CONCLUSION:Steroid withdrawal is feasible and safe in HTx patients. In our study, it was successfully maintained in 63% of the patients. EMB is helpful to identify patients with acute rejection at 1 and 3 months after withdrawal. Short- to mid-term metabolic benefits are significant reductions in serum total and LDL cholesterol.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Castel MA,Vallejos I,Ramos P,Arias A,Bravo C,Ferrero M,Rivero D,Sionis A,Pérez-Villa F,Roig E

doi

10.1016/j.transproceed.2009.06.028

subject

Has Abstract

pub_date

2009-07-01 00:00:00

pages

2253-5

issue

6

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(09)00749-0

journal_volume

41

pub_type

杂志文章

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