Steroid-free maintenance immunosuppression after heart transplantation

Background. Steroids are routinely used in almost all immunosuppressive pro tocols after cardiac transplantation. The metabolic side effects of steroid s are well known and could lead to significant morbidity and mortality in t he posttransplant period. There is growing evidence to suggest that steroid s may not be a requirement for adequate immunosuppression and that morbidit y may be reduced by withdrawing steroids in select patients. We have review ed our series of patients undergoing heart transplantation in whom steroids were weaned postoperatively. Methods. We retrospectively reviewed all adult patients undergoing heart tr ansplantation at our institution between November 1993 and April 2000 treat ed with a triple-drug immunosuppressive regimen. Medications were recorded at discharge and at 6, 12, and 24 months posttransplant to determine the su ccess of steroid weaning. Freedom from infection and rejection as well as o verall survival was calculated using Kaplan-Meier methods. Results. By 24 months posttransplant, almost 70% of patients were receiving double-drug therapy. Survival for the entire group was excellent with 1(.) , 3-, and 5-year survival of 98% +/- 2.0%, 93.2% +/- 3.8%, and 88.3% +/- 6. 0%, respectively. Freedom from rejection at 6 months was 60.7% +/- 6.5%, at 1 year was 60.7% +/- 6.5%, and at 2 years was 58.5% +/- 6.7%. Infectious c omplications were low with freedom from infection at 6 months of 78.5 +/- 5 .5%, at 1 year of 76.5% +/- 5.7%, and at 2 years of 72.0% +/- 6.2%. Conclusions. Our data suggest that an immunosuppressive regimen without lon g-term steroid administration results in excellent survival rates without a n apparent increase in rejection or infectious complications. (C) 2001 by T he Society of Thoracic Surgeons.