Treatment of cardiac allograft rejection with intravenous corticosteroids

The treatment of cardiac allograft rejection remains complex and is influenced by a number of factors, including hemodynamic compromise, severity of biopsy grade, time after transplantation, gender, and local institutional bias. This article reports the response of 43 rejection episodes in 67 patients who underwent orthotopic heart transplantation in a 3-year period and who were treated with triple-drug immunosuppression only. Eighty-eight percent (38 of 43) of the rejection episodes were treated initially with one course (3 gm) of intravenous methylprednisolone, and 82% (31 of 38) responded. Another 7% responded to a second course of intravenous corticosteroids, and the remaining 11% of the episodes eventually required the use of antilymphoblast globulin for resolution. Twelve percent of the rejections (n = 5) were initially treated with antilymphoblast globulin, and three responded. The response of cardiac allograft rejection to intravenous corticosteroids is greater than 85%, and this should be the initial treatment in most cases of rejection. The role of advanced biopsy grade, dose of corticosteroids used, and complications resulting from this form of therapy are discussed.