Premium
Corticosteroid wean after heart transplantation—Is there a risk for antibody formation?
Author(s) -
Elboudwarej Omeed,
Phan Derek,
Patel Jignesh K.,
Liou Frank,
Aintablian Tamar,
Osborne Ashley,
Yu Zhe,
Reinsmoen Nancy,
Kobashigawa Jon A.
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12916
Subject(s) - medicine , prednisone , corticosteroid , heart transplantation , panel reactive antibody , transplantation , gastroenterology , antibody , immunosuppression , surgery , cardiology , immunology , kidney transplantation
Background Corticosteroid withdrawal after heart transplantation is limited to select immune‐privileged patients but it is not known whether this predisposes patients to a higher risk for sensitization. Methods A total of 178 heart transplant recipients had panel‐reactive antibody (PRA) measurements at transplant and every 6 months and were monitored for rejection with protocol endomyocardial biopsies. Corticosteroid withdrawal was initiated at 6 months post‐transplant in select patients. Results Patients successfully weaned off prednisone (SPW; n=103) had lower PRA compared to those maintained on prednisone (MP; n=51) at pretransplant (34% vs 63%), 6 months (18% vs 49%), 12 months (19% vs 51%), and 18 months (15% vs 47%) after transplant ( P <.05). Among 68 nonsensitized patients at transplant in the SPW group, seven (10%) developed de novo PRA at 12 months, compared to four of 19 (21%) of MP patients. Freedom from any treated rejection (97% vs 69% vs 67%), acute cellular rejection (100% vs 86% vs 71%), and antibody‐mediated rejection (100% vs 88% vs 88%; all P ≤.001) at 2 years was higher in SPW compared to MP and those who failed prednisone wean, respectively. Conclusion Few patients successfully weaned off prednisone after heart transplant develop de novo circulating antibodies but are not at increased risk for developing rejection.