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Aggressive steroid weaning after cardiac transplantation is possible without the additional risk of significant rejection
Author(s) -
Teuteberg Jeffrey J.,
Shullo Michael,
Zomak Rachelle,
McNamara Dennis,
McCurry Kenneth,
Kormos Robert L.
Publication year - 2008
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/j.1399-0012.2008.00868.x
Subject(s) - medicine , steroid , calcineurin , tacrolimus , weaning , transplantation , incidence (geometry) , heart transplantation , retrospective cohort study , regimen , gastroenterology , surgery , physics , hormone , optics
Background: Chronic steroid use after cardiac transplantation (CTX) is accompanied by co‐morbidities that are dependent on length of exposure. Methods: A retrospective review of all CTX without induction therapy from 1999–2004. After 2001, an aggressive strategy of steroid weaning was introduced. Results: A total of 165 patients underwent CTX, 82 from 1999–2001 (group 1) and 83 from 2002–2004 (group 2). There were no significant differences in recipient or donor characteristics between group 1 and group 2. The baseline calcineurin was cyclosporine in 41% and 5% (p < 0.0001) and tacrolimus in 59% and 95% (p < 0.0001), respectively. The mean duration of steroid use was 1023 d in group 1 and 383 d in group 2 (p < 0.0001). The overall incidence of any ≥ISHLT grade 3A rejection per year after CTX for group 1 vs. group 2 was as follows: year 1: 40% vs. 49% (p = NS) and year 2: 7.4% vs. 9.2% (p = NS). Conclusions: Steroid withdrawal by one yr after CTX using a contemporary immunosuppressive regimen is possible in most patients. In comparison with a slower steroid wean, a faster wean is not associated with an excess of significant rejection in the first two yr post CTX.