ACTINOMYCIN-D IS AN EFFECTIVE ADJUNCTIVE IMMUNOSUPPRESSIVE AGENT IN RECURRENT CARDIAC ALLOGRAFT-REJECTION

Background: Actinomycin D is a potent cytotoxic agent which inhibits D NA transcription by DNA-dependent RNA polymerases and has previously b een used as adjunctive immunosuppressive agent for refractory renal al lograft rejection. Methods: To assess the efficacy of actinomycin D in cardiac allograft rejection, we studied seven patients with recurrent cellular or humoral rejection. All patients received intravenous acti nomycin D 5 mu g/kg every 6 weeks. Results: During the 6-months after initiation of actinomycin D treatment, the mean number of treated cell ular or humoral rejection episodes per patient (0.14) and the mean num ber of International Society for Heart and Lung Transplantation grade 2 or higher endomyocardial biopsy specimens per patient (0.3) were low er compared with those observed during the 6-month pre-actinomycin D p eriod (1.6 and 2.6, respectively). By 6 months after initiation of act inomycin D, all seven patients were receiving lower daily maintenance doses of corticosteroids. The mean total corticosteroid dose after act inomycin D administration per patient per month (615 +/- 177 mg) was s ignificantly lower than the pre-actinomycin D dose (1012 +/- 347 mg; p = 0.019). No patient had significant adverse effects. Conclusions: Ac tinomycin D is an effective immunosuppressive agent for prevention of recurrent cellular or humoral rejection after cardiac allograft reject ion. The corticosteroid sparing effect of actinomycin D may be of part icular benefit.