Related Experiment Videos
Steroid withdrawal in the pediatric heart transplant recipient initially treated with triple immunosuppression
C E Canter1, S Moorhead, J E Saffitz
1Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, MO 63110.
Insights
Steroid withdrawal after pediatric heart transplantation is feasible, with 81% of patients successfully discontinuing steroids. Close monitoring is essential to manage potential rejection episodes post-withdrawal.
Area of Science:
- Pediatric Cardiology
- Immunosuppression Therapy
- Transplantation Medicine
Background:
- Corticosteroids are a key component of triple immunosuppression post-heart transplantation.
- Long-term steroid use is associated with significant adverse effects in pediatric patients.
Purpose of the Study:
- To assess the feasibility and safety of withdrawing corticosteroids 6 to 12 months after pediatric heart transplantation.
- To evaluate the incidence of rejection after steroid discontinuation in this population.
Main Methods:
- Prospective evaluation of 26 pediatric heart transplant recipients on triple immunosuppression (cyclosporine, azathioprine, corticosteroids).
- Steroid withdrawal initiated 6-12 months post-transplant with elective endomyocardial biopsy within 2 weeks of discontinuation.
- Surveillance for significant rejection (grade 2 or higher) via endomyocardial biopsy.
Main Results:
- Twenty-one of 23 (91%) six-month survivors had steroids withdrawn.
- Seventeen of 21 (81%) patients were successfully maintained without steroids for a mean of 17 months.
- Five of 21 (24%) patients experienced rejection within 6 months post-steroid withdrawal, with one requiring retransplantation and another dying suddenly.
Conclusions:
- Steroid withdrawal is feasible in select pediatric heart transplant recipients.
- Careful monitoring for rejection is crucial following corticosteroid discontinuation.
- Long-term outcomes require further investigation, especially in patients experiencing rejection post-withdrawal.
Abstract:
We prospectively evaluated the feasibility of withdrawing steroids 6 to 12 months after heart transplantation in 26 consecutive infants and children (median age at transplantation 6 weeks; range 5 days to 10.1 years) initially treated with triple immunosuppression (cyclosporine, azathioprine, and corticosteroids). Ongoing surveillance for cellular rejection was performed by endomyocardial biopsy in all patients and was performed electively in all subjects within 2 weeks after administration of steroids was discontinued. Significant rejection was defined as grade 2. Twenty-three of 26 patients were 6-month survivors and steroids were withdrawn in 21, with the other two survivors followed up elsewhere with triple immunosuppression. Seventeen (81%) of 21 patients were ultimately treated without maintenance steroids for a mean duration of 17 months (range 1 to 34 months), including 6 of 17 patients who had at least one episode of rejection within the first 6 months of transplantation. Five (24%) of 21 patients had rejection 2 weeks (n = 3) and 6 months (n = 2) after steroids were withdrawn, with one patient successfully withdrawn from steroids after a second attempt. In this latter group one patient underwent retransplantation because of severe coronary arteriopathy by angiography 10 months after transplantation and another died suddenly 18 months after transplantation despite resumption of steroids.(ABSTRACT TRUNCATED AT 250 WORDS)