Heart allograft rejection under varying immunosuppressive protocols as evaluated by endomyocardial biopsy.
Rejection episodes in 259 heart allograft recipients and 29 heart-lung transplant patients at Stanford University were examined from the viewpoint of endomyocardial biopsy. The patients were divided into the following six groups by immunosuppressive regimen: Group 1 (100 patients) was treated with conventional immunosuppression. Group 2 (26 patients) was treated with cyclosporine in combination with low-dose corticosteroids and an initial 3- to 4-day course of rabbit antithymocyte globulin. Group 3 (76 patients) was treated with cyclosporine and low-dose corticosteroids. Group 4 (34 patients) was treated with low-dose cyclosporine, azathioprine, and low-dose corticosteroids. Group 5 (23 patients) was treated with low-dose cyclosporine and azathioprine, but initially without low-dose corticosteroids. Group 6 was composed of 29 heart-lung transplant recipients. Groups 1, 2, and 6 had significantly less rejection episodes than group 3, and groups 4 and 5 had more rejection episodes than group 3. In patients with a diagnosis of mild acute rejection on cyclosporine, a repeat biopsy shows progression to a moderate acute rejection in 21% to 43% of cases, emphasizing the importance of this diagnosis even in cyclosporine-treated patients. The characteristics of acute heart allograft rejection as assessed by endomyocardial biopsy are important to recognize. In part as a result of the data presented here, further modifications in the immunosuppressive regimen of the Stanford heart and heart-lung transplant recipients are being undertaken.
Imakita
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D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004699:Endocardium / Q000473:pathology*; D006084:Graft Rejection / Q000187:drug effects*; D006321:Heart / Q000187:drug effects; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008168:Lung / Q000187:drug effects; D016040:Lung Transplantation; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011241:Prednisone / Q000627:therapeutic use
D003524:Cyclosporins; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone