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Ann Thorac Surg 1993;55:1160-1165
© 1993 The Society of Thoracic Surgeons
Departments of Cardiovascular Surgery, Cardiology, and Pathology, University of Padova, Padova, Italy
Accepted for publication August 12, 1992.
* Address reprint requests to Dr Livi, Istituto di Chirurgia Cardiovascolare, Centro di Cardiochirurgia "V. Gallucci," Università di Padova, Via Giustiniani 2, Padova, 35128, Italy.
Between January 1987 and September 1991, 112 operative survivors of heart transplantation were initially immunosuppressed with cyclosporin A and azathioprine without prednisone. Eighty-eight patients (79%) remained on a regimen of double therapy for a mean follow-up of 25 ± 15 months (range, 1 to 54 months), whereas 24 patients (21%) had oral prednisone, 5 mg/day, added to maintenance therapy for persistent or repeated rejection. There were 5 early deaths (4%) because of acute rejection (4 patients) or infection (1 patient). Only 1 patient died late after heart transplantation of chronic rejection. Actuarial survival was 95% ± 2% and 94% ± 3% at 12 and 48 months, respectively. Mean rate of acute rejection was 1.7 ± 1.0 episodes per patient, with a 5% ± 2% freedom from rejection at 48 months. Ten patients (9%) required in-hospital treatment for infection; the actuarial freedom from infectious episodes was 85% ± 4% at 48 months. Actuarial freedom from hypertension was 43% ± 7% at 48 months. At annual catheterization, mean left ventricular ejection fraction was 0.64 ± 0.08 and 0.62 ± 0.05 at 1 year and 4 years, respectively, with evidence of coronary lesions in 8 patients (8%). In conclusion, steroid-free immunosuppression after heart transplantation is associated with a high incidence of acute rejection. However, the excellent medico-term survival and the low incidence of both infection and chronic rejection seem to justify a wider use of such treatment.
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