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Steroid‐free and steroid withdrawal protocols in heart transplantation: the review of literature
Author(s) -
Baraldo Massimo,
Gregoraci Giorgia,
Livi Ugolino
Publication year - 2014
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12309
Subject(s) - medicine , steroid , heart transplantation , transplantation , steroid use , hormone
Summary Corticosteroids ( CS s) are still the mainstay of induction, rescue, and maintenance in heart transplantation ( HT x). However, their use is associated with significant and well‐documented side effects usually related to the dose administered and the duration of therapy. Moreover, CS s interfere with the recipient's quality of life and with the active process of graft tolerance. Physicians have been exploring ways to avoid or reduce CS s in association with other immunosuppressive drugs, minimizing side effects and costs. The regimens are classified as steroid‐free or steroid withdrawal protocols. The studies analyzed in this review come to similar conclusions as benefits and adverse consequences: steroid‐free protocols should be advisable and mandatory in pediatric patients, insulin‐dependent diabetes mellitus ( IDDM ), presence of infection, familial metabolic disorders/obesity, severe osteoporosis, and in the elderly. On the other hand, steroid withdrawal can be successfully achieved in 50–80%, with late better than early withdrawal, no increase in rejection‐related mortality, no adverse impact on survival, and probably a better quality of live. Safety and efficacy can certainly be improved by an individualized approach to the transplant recipient.

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