Successful withdrawal of corticosteroids in heart transplantation

The ability to withdrawal corticosteroids from the maintenance immunosuppression regimen has been reported in heart transplant recipients. Most patients tested have had corticosteroids discontinued by 3 to 4 weeks after transplantation and have received perioperative administration of lymphocyte antibody therapy. To assess the importance of the additional "induction" therapy and the comparative results of delaying steroid withdrawal until after most rejections had occurred in our program, we withdrew maintenance steroids from 48 patients who were an average of 11 months (median, 8.6 months, range, 5 to 59 months) after transplantation. Mean patient age was 48 years, 95% were men, and 60% of the patients had never been treated for rejection before steroid withdrawal. Forty of the 48 patients (82%) were successfully withdrawn and remain free of steroids with an average of 25 months (range, 5 to 39 months) of follow-up off steroids. Ten episodes of rejection occurred in eight patients (82% rejection free). Six patients had a single rejection and two had more than one rejection. The average time to rejection after steroid withdrawal was 4 1/2 months, but two patients developed their first-ever rejection at 11 1/2 and 12 1/2 months after steroid withdrawal. Three of the rejections after steroid withdrawal were treated with intravenous steroids (10 mg/kg/day for 3 days) without a return to maintenance steroids. These three patients have not had a subsequent episode of rejection in 15 months of follow-up. The other three patients with rejection were returned to steroid therapy because of an inability to tolerate azathioprine, as were three patients without rejection for unrelated reasons.(ABSTRACT TRUNCATED AT 250 WORDS)