METHOTREXATE AS RESCUE ADJUNCTIVE IMMUNOTHERAPY IN INFANT AND ADULT HEART-TRANSPLANTATION

Methotrexate may be a useful adjunct to more conventional immunosuppre ssion in heart transplantation, but experience is limited. We report o ur findings in 18 patients aged 19 days to 64 years, who were treated with methotrexate. Five patients were less than 1 year of age; 11 pati ents were over 16 years of age. Indications could be divided in two gr oups. Seven patients were treated with methotrexate as rescue therapy for unresolving acute grade 3 rejection or for early recurrence after one rejection episode that had been treated with steroids and antilymp hocyte serum. All infants were treated with methotrexate for life-thre atening rejection. Methotrexate was given as an adjunct to conventiona l treatment in six patients for mild rejection, which occurred while s teroids were being decreased or in patients with relative contraindica tions to high-dose steroids. One grade 3b rejection could not be rever sed with methotrexate and led to the patient's death 3 months later. O ne grade 1b rejection only temporarily improved and was actually rever sed with high-dose steroids after 4 months. All other rejections were rapidly reversed with the use of methotrexate. Tolerance of methotrexa te has been very good with transient leukopenia in four patients, with ulcerative stomatitis in one patient, and with transient elevation of liver enzymes in two patients. We conclude that methotrexate is a val uable rescue/adjunctive immunotherapeutic agent that is capable of alt ering heart rejection with considerable safety and efficacy.