[Management of rejection following heart transplantation using oral steroid medication]

After 47 orthotopic heart transplantations with long-term immunosuppression (cyclosporin A, 3-10 mg/kg; azathioprine, 1-2 mg/kg; prednisolone 0.1 mg/kg) there were 306 episodes of acute rejection. In 44 of these (14.8%) the oral prednisolone dosage was increased, from a mean of 10.8 +/- 2.95 mg/d to 36.6 +/- 7.2 mg/d, followed by stepwise reduction to the original maintenance dose. Compared with the customary intravenous bolus administration (1.0 g/d for three days: success rate 89%), the oral schedule was successful in 33 of the 44 episodes of rejection (75%). It is concluded that in selected patients acute rejection episodes after heart transplantation can be successful treated by an increase in the oral dose of steroids without changing the dosage of the other two immunosuppressive drugs.