Methylprednisolone pulsing of heart transplant patients in the home

Methylprednisolone pulsing is the first form of treatment used to reverse acute moderate rejection in heart transplant patients at the University of Michigan, Ann Arbor. Before May 1986, patients who needed administration of medications to be pulsed were admitted to the hospital. With our increasing number of transplant patients, lack of hospital beds, and efforts toward cost containment, a new system was established. From June 1986 to April 1988, 53 heart transplantations were performed in 40 adults and 13 children. Home care agency nurses received in-service training by the heart transplant clinical specialist. Insurance companies were contacted directly to obtain financial approval when it was not considered a covered benefit. Of 47 episodes of rejection, 45 were successfully treated in the home with resolution, whereas hospital admission was required in two cases of rejection episodes for successful resolution. There were marked financial savings, increased patient satisfaction, no patient infections, and minimal side effects, which included hypertension in five patients, headaches in two patients, and difficulty gaining venous access in two patients. Most problems were easily handled by telephone communication. Therefore, after a 22-month experience with administration of methylprednisolone pulses in the home, we believe that this is a satisfactory method of treating patients. It is cost-effective, has minimal side effects, and leads to increased patient satisfaction.