URATE OXIDASE FOR THE TREATMENT OF TOPHAC EOUS GOUT IN HEART-TRANSPLANT RECIPIENTS - A REPORT OF 3 CASES

Gout in heart transplant recipients is common and poses a significant therapeutic challenge. Concomitant administration of azathioprine and allopurinol therapy carries a high risk of leukopenia. Uricosuric agen ts can cause renal lithiasis and/or acute renal failure in patients wi th renal failure and/or high urinary levels of uric acid. We report ou r experience with urate-oxidase in three heart transplant recipients w ith severe polyarticular and tophaceous gout, a history of leukopenia under allopurinol and unresponsiveness or contraindications to uricosu ric agents. Urate-oxidase was given parenterally in a dosage of 1000 u nits per day, seven days a month. The injections were done intramuscul arly in one patient and intravenously in the other two, who were under anticoagulant therapy. Patients 1 and 2 received 12 and 6 courses, re spectively. The third patient had had four courses and was still under treatment at the time of this writing. Shrinking of the tophi and imp roved mobility of the fingers were seen in all three patients after th e second course. No adverse effects were recorded. Our experience sugg ests that urate-oxidase therapy may decrease the urate burden in patie nts with severe tophaceous gout. Urate-oxidase therapy should be viewe d as a phase in the treatment of gout, which must be followed by admin istration of another agent.