Related Experiment Videos
[Should mild acute rejection of a cardiac graft be treated?]
M Desruennes1, F Aboujaoude, J J Ghoussoub
1Service de Chirurgie cardio-vasculaire, Hôpital de La Pitié, Paris.
Insights
Increasing oral corticosteroid therapy effectively treats mild acute cardiac allograft rejection, preventing progression to moderate rejection. This approach avoids more aggressive immunosuppression and associated risks.
Area of Science:
- Cardiology
- Immunology
- Transplantation Medicine
Context:
- Acute cardiac allograft rejection is a significant concern post-heart transplantation.
- Mild rejection episodes can progress to moderate rejection without intervention.
- Current management strategies for mild rejection vary.
Purpose:
- To evaluate the effectiveness of increased oral corticosteroid therapy for mild acute cardiac allograft rejection.
- To compare outcomes of untreated mild rejection versus intensified corticosteroid treatment.
- To assess the impact of treatment on rejection progression and patient outcomes.
Summary:
- A study analyzed 300 mild acute cardiac allograft rejections in 120 patients.
- Untreated mild rejection progressed in 20% of cases, while intensified oral corticosteroids reduced progression to 5% (p<0.05).
- Severe rejections treated with intensive immunosuppression showed complete resolution of heart failure symptoms.
Impact:
- Increased oral corticosteroid therapy is effective in managing mild acute cardiac allograft rejection.
- This treatment strategy prevents progression to more severe rejection, reducing the need for major immunosuppression.
- Effective management of mild rejection minimizes risks of infection and mortality associated with intensive immunosuppressive treatments.
Abstract:
With no additional therapy, mild acute cardiac allograft rejection progresses in 30 per cent of the cases towards moderate rejection. Three hundred mild rejections which occurred in 120 patients between May 1987 and May 1989 were studied and divided into 3 groups according to their treatment. Group I rejections (n = 108) were left untreated. In group II rejections (n = 186), the dose of oral corticosteroid therapy was increased, and in group III rejections (n = 6) major immunosuppressive treatment with methylprednisolone and antilymphocyte globulins (or Orthoclone OKT3) were initiated in view of the clinical and echocardiographic severity of the rejection. In the untreated group, 20 per cent of mild rejection progressed to moderate rejection, while 67 per cent are still at a mild stage in control myocardial biopsies. In group II, only 5 per cent of mild rejections have become moderate, and 19 per cent persisted as mild in control biopsies (p less than 0.05). The treatment of group III rejections resulted in complete disappearance of signs of heart failure and improvement of right and left ventricular contractile functions, proving that severe rejection was cured. This study demonstrates the effectiveness of increased oral corticosteroid therapy in minimal acute cardiac allograft rejections, without significant increase in infection or mortality rate. The principal reason for treating mild acute cardiac allograft rejections is to prevent their progression towards moderate rejections which require major immunosuppressive treatments and therefore have higher post-transplantation infection and mortality rates.