ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Michael E. Jessen
Dan M. Meyer
Michael A. Wait
W. Steves Ring
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Rosenbaum, D. H.
Right arrow Articles by DiMaio, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Rosenbaum, D. H.
Right arrow Articles by DiMaio, J. M.
Related Collections
Right arrow Transplantation - heart

Ann Thorac Surg 2006;82:637-644
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Effects of Early Steroid Withdrawal After Heart Transplantation

David H. Rosenbaum, MDa, Brian C. Adams, BSa, Joshua D. Mitchell, BSa, Michael E. Jessen, MDa, Michelle C. Paul, BSa, Patricia A. Kaiser, RNa, Paul A. Pappas, MSb, Dan M. Meyer, MDa, Michael A. Wait, MDa, Mark H. Drazner, MDc, Clyde W. Yancy, Jr, MDc, W. Steves Ring, MDa, J. Michael DiMaio, MDa,*

a Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
c Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
b Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina

Accepted for publication March 22, 2006.

* Address correspondence to Dr DiMaio, 5323 Harry Hines Blvd, Dallas, TX 75390-8879. (Email: michael.dimaio{at}utsouthwestern.edu).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

BACKGROUND: Managing immunosuppression is a significant aspect of posttransplantation patient care. Previously, our institution reported that prednisone could be withdrawn in cardiac allograft recipients without jeopardizing midterm survival. We returned to this group of patients to investigate the long-term effects of our steroid taper protocol.

METHODS: We reviewed the records of 162 consecutive cardiac transplant recipients from our institution. Patients who underwent transplantation between 1988 and 1990 were treated with traditional triple-therapy immunosuppression (cyclosporine, azathioprine, and prednisone). Beginning June 1990, we instituted a protocol of early steroid taper with discontinuation by 6 months after transplant. The two groups were comparable with respect to age, sex, ethnicity, cause of heart failure, ischemic time, body mass index, and creatinine at the time of transplantation.

RESULTS: Fifty-seven percent of the patients in the early steroid taper group were successfully withdrawn from steroids at 6 months after transplantation. This group had a decreased freedom from and increased frequency of acute rejection (p < 0.01 for each) when compared with the traditional therapy group. There was, however, no difference in freedom from posttransplant coronary artery disease (p = 0.53). The early steroid taper group enjoyed an increased freedom from malignancy (p = 0.01) and trended toward a decreased frequency of infection (p = 0.10) and improved survival (p = 0.06).

CONCLUSIONS: Steroid withdrawal is possible in 57% of patients at 6 months after transplantation. The institution of an early steroid taper protocol improves the overall freedom from malignancies and may decrease the frequency of infection and prolong overall survival without increasing the risk of posttransplant coronary artery disease.




This article has been cited by other articles:


Home page
 The Annals of PharmacotherapyHome page
S. Lam, N. Partovi, L. S. Ting, and M. H. Ensom
Corticosteroid Interactions with Cyclosporine, Tacrolimus, Mycophenolate, and Sirolimus: Fact or Fiction?
Ann. Pharmacother., July 1, 2008; 42(7): 1037 - 1047.
[Abstract] [Full Text] [PDF]

Home page
 J CARDIOVASC PHARMACOL THERHome page
N. Z. Sulemanjee, R. Merla, S. D. Lick, S. M. Aunon, M. Taylor, M. Manson, L. S.C. Czer, and E. R. Schwarz
The First Year Post-Heart Transplantation: Use of Immunosuppressive Drugs and Early Complications
Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2008; 13(1): 13 - 31.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.