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Steroid-free maintenance immunotherapy: Minneapolis Heart Institute experience
M R Pritzker1, K D Lake, T J Reutzel
1Minneapolis Heart Institute, MN 55407.
Summary
Steroid-free immunosuppression after heart transplant shows promise, delaying rejection but increasing early bacterial infections. This approach offers potential benefits over long-term prednisone use.
Area of Science:
- Immunology
- Cardiology
- Transplantation Medicine
Background:
- Immunotherapy advances improve heart transplant survival.
- OKT3 induction allows prednisone withdrawal in select patients.
- Steroid-free regimens may reduce long-term complications.
Purpose of the Study:
- Compare long-term efficacy and toxicity of steroid-free vs. triple-drug immunosuppression post-heart transplant.
- Evaluate outcomes in patients receiving OKT3 induction and steroid withdrawal.
Main Methods:
- Retrospective review of 68 heart transplant patients (1988-1990).
- Comparison of patients on OKT3 induction with steroid-free maintenance vs. triple-drug therapy.
- Analysis of rejection rates, infection incidence, and hypertension.
Main Results:
- Equivalent treated rejection rates between groups.
- Significantly longer time to first rejection in the OKT3/steroid-free group (205 vs. 27 days).
- Increased early bacterial infections in the OKT3/steroid-free group; similar fungal/viral infections. Hypertension slightly higher with prednisone.
Conclusions:
- Steroid-free maintenance immunosuppression after heart transplantation is feasible.
- This approach may delay rejection episodes compared to triple-drug therapy.
- Careful monitoring for early bacterial infections is crucial in steroid-free regimens.