Pulsed steroids for treatment of cardiac rejection after transplantation. What dosage is necessary?
For treatment of biopsy-proven rejections after cardiac transplantation, pulsed steroids of 1,000 mg methylprednisolone/day for 3 days have been conventionally used. This regimen results in severe side effects, both metabolically and with respect to the risk of infection. In a prospective and a more comprehensive retrospective clinical study, we investigated the effect of a 50% reduction in that dosage. A total of 512 positive biopsies were analyzed in 128 patients. Of these, 64 patients (120 biopsies) in group 1 received 500 mg/day for 3 days while the remaining 107 patients (392 biopsies) in group 2 were treated with 1,000 mg/day for 3 days (43 patients belonged to both groups 1 and 2). Response to treatment was assessed by control biopsies in a standardized time period until the next biopsy-proven rejection (maximum of 10 biopsies). The results in short and longer follow-up periods, considering the incidence and a newer empirical numerical grading scale, have demonstrated clearly comparable effects of myocardial histology. Reduced dosage of steroids is feasible and safe, and a decrease in steroid-related side effects can be achieved without jeopardizing the graft.
Heublein
B
B
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, FRG.
Wahlers
T
T
Haverich
A
A
D000328:Adult; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000187:drug effects*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
D008775:Methylprednisolone