Cardiac allograft function with corticosteroid-free maintenance immunosuppression

Potent prophylactic immunosuppressive protocols promote the safe withdrawal of corticosteroid maintenance. The benefits of corticosteroid-free maintenance immunosuppression include the absence of the cushingoid habitus, fewer infections, less obesity, and lower serum cholesterol. The incidence of al...

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Bibliographic Details
Published inCirculation (New York, N.Y.) Vol. 82; no. 5 Suppl; p. IV318
Main Authors O'Connell, J B, Bristow, M R, Rasmussen, L G, Ratkovec, R M, Gay, Jr, W A, Jones, K W, Renlund, D G
Format Journal Article
LanguageEnglish
Published United States 01.11.1990
Subjects
Antibodies, Monoclonal - therapeutic use
Antilymphocyte Serum - therapeutic use
Female
Follow-Up Studies
Graft Rejection - drug effects
Heart Transplantation
Humans
Immunosuppression - methods
Immunosuppressive Agents - therapeutic use
Male
Middle Aged
Muromonab-CD3
Prednisone - adverse effects
Prednisone - therapeutic use
Substance Withdrawal Syndrome
Time Factors
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Summary:Potent prophylactic immunosuppressive protocols promote the safe withdrawal of corticosteroid maintenance. The benefits of corticosteroid-free maintenance immunosuppression include the absence of the cushingoid habitus, fewer infections, less obesity, and lower serum cholesterol. The incidence of allograft coronary artery disease is not increased by corticosteroid-free maintenance. To assess the long-term effects of corticosteroid-free immunosuppression on allograft function, we compared results of hemodynamic study and noninvasive evaluation over the 2-year follow-up of 57 patients on corticosteroid-free maintenance to 40 patients who required corticosteroid. Age and pretransplantation diagnoses were similar, but a greater percentage of those who required corticosteroid maintenance were female (28% versus 2%, p less than 0.001). Indexes of allograft function were similar in both groups and these indexes included ejection fraction, right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, left ventricular end-diastolic dimension, and posterior wall thickness. Patient survival was identical in the two groups (98%). These data indicate that corticosteroids can be safely withdrawn with the subsequent early benefits and without compromising long-term allograft function.
ISSN:0009-7322