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Outcome after steroid withdrawal in heart transplantation

M A Castel1, I Vallejos, P Ramos

  • 1Thorax Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain. macastel@clinic.ub.es

Transplantation Proceedings
|September 1, 2009
PubMed

Insights

Late steroid withdrawal after heart transplantation (HTx) is feasible and safe, with 63% of patients remaining steroid-free. This approach offers metabolic benefits like reduced cholesterol levels.

Area of Science:

  • Cardiology
  • Immunology
  • Transplantation Medicine

Background:

  • Limited data exists on late steroid withdrawal post-heart transplantation (HTx).
  • Lack of consensus hinders assessment of steroid withdrawal impact.
  • Current study investigates safety and feasibility of corticosteroid withdrawal at 1 year post-HTx.

Purpose of the Study:

  • To evaluate the safety and feasibility of corticosteroid withdrawal one year after heart transplantation.
  • To assess the long-term outcomes of steroid withdrawal in heart transplant recipients.
  • To identify potential benefits and risks associated with late steroid withdrawal.

Main Methods:

  • Steroid withdrawal attempted in 86 heart transplant patients after 12 months of treatment.
  • Endomyocardial biopsies (EMB) performed at 1 and 3 months post-discontinuation.
  • Mean follow-up duration of 25 months.

Main Results:

  • 63% of patients successfully remained steroid-free.
  • Corticosteroids were reinitiated in 35% of patients due to rejection, renal dysfunction, malignancy, adverse effects, or allograft coronary artery disease.
  • Significant reductions observed in total cholesterol and LDL cholesterol levels.
  • No significant difference in mortality between steroid-free and steroid-maintained groups.

Conclusions:

  • Late steroid withdrawal is feasible and safe in heart transplant patients.
  • Successful steroid-free maintenance achieved in 63% of patients.
  • Endomyocardial biopsies are crucial for monitoring acute rejection post-withdrawal.
  • Short- to mid-term benefits include improved lipid profiles.
Abstract

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