ADJUVANT TREATMENT WITH URSODEOXYCHOLIC ACID MAY REDUCE THE INCIDENCEOF ACUTE CARDIAC ALLOGRAFT-REJECTION

Background: The nontoxic bile acid, ursodeoxycholic acid (UDCA), is an effective drug for the treatment of different cholestatic conditions. Furthermore, an immunomodulatory capacity of UDCA has been reported i n vitro, as well as in vivo, in different immune-mediated liver diseas es and after liver transplantation. Methods: In this retrospective stu dy, the influence of UDCA on heart transplant rejection was investigat ed in 21 cardiac allograft recipients receiving UDCA for cyclosporine- induced cholestasis (500 mg administered twice daily, start of therapy within the first postoperative month, duration >8 weeks). Thirty-one patients not receiving UDCA served as control subjects. All patients r eceived triple-maintenance immunosuppression (cyclosporine, azathiopri ne, prednisolone). For quantitative comparison of rejection severity, the following score was applied: 0, no specific therapy; 1, temporary increase in oral steroids; 2, intravenous steroids; 3, ATG or OKT3 the rapy. Results: During the first 6 postoperative months, the number of acute rejection episodes requiring specific anti-rejection therapy was significantly lower in the UDCA group as compared with control subjec ts (1.38 +/- 1.36 vs 2.74 +/- 1.83 rejection episodes per patient, p = 0.005). The cumulative score was significantly lower in the UDCA grou p as compared with control subjects (2.38 +/- 2.29 vs 5.06 +/- 3.61, p = 0.004). Conclusions: These initial data indicate a beneficial effec t of adjuvant UDCA treatment in the early phase after heart transplant ation probably related to immunomodulating properties of UDCA, which m ay be used therapeutically after organ transplantation.