CORTICOSTEROID WEANING LATE AFTER HEART-TRANSPLANTATION - RELATION TOHLA-DR MISMATCHING AND LONG-TERM METABOLIC BENEFITS

Background: To avoid the long-term side effects of corticosteroids, co rticosteroid-free immunosuppression has been introduced immediately or late (more than 6 months) after heart transplantation. Late corticost eroid weaning may have a higher success rate as patients are selected on the basis of rejection history. Previous reports of HLA-DR mismatch ing and the long-term metabolic benefits with respect to corticosteroi d weaning have been equivocal. Methods: One hundred and one eligible h eart transplant recipients receiving triple-drug immunosuppression 6 m onths from heart transplantation were weaned from prednisone by decrea sing the daily prednisone dose by 1 mg each month. Moderate rejection episodes were recorded and after conclusion of the study, HLA-DR misma tching of recipient and donor was reviewed. Serum cholesterol level, b ody weight, and number of patients receiving blood pressure medication s were recorded before and 1 year after corticosteroid weaning. Result s: Successful weaning from corticosteroids was achieved in 82% of pati ents. Of 31 patients with zero or one HLA-DR mismatch, 30 (97%) were s uccessfully weaned. For those patients more than 1 year after disconti nuation of corticosteroids, 67 had more weight loss and a lower serum cholesterol level than 15 patients who were unsuccessful at corticoste roid weaning and dependent on corticosteroids. Conclusions: Heart tran splant recipients can safely be weaned from corticosteroids late after heart transplantation with zero or one HLA-DR mismatch conferring a h igher success rate. The long-term metabolic benefits of corticosteroid weaning include a reduction in weight and serum cholesterol.