Ja. Kobashigawa et al., CORTICOSTEROID WEANING LATE AFTER HEART-TRANSPLANTATION - RELATION TOHLA-DR MISMATCHING AND LONG-TERM METABOLIC BENEFITS, The Journal of heart and lung transplantation, 14(5), 1995, pp. 963-967
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.