Actinomycin D is an effective adjunctive immunosuppressive agent in recurrent cardiac allograft rejection.
BACKGROUND
Actinomycin D is a potent cytotoxic agent which inhibits DNA transcription by DNA-dependent RNA polymerases and has previously been used as adjunctive immunosuppressive agent for refractory renal allograft rejection.


METHODS
To assess the efficacy of actinomycin D in cardiac allograft rejection, we studied seven patients with recurrent cellular or humoral rejection. All patients received intravenous actinomycin D 5 micrograms/kg every 6 weeks.


RESULTS
During the 6-months after initiation of actinomycin D treatment, the mean number of treated cellular or humoral rejection episodes per patient (0.14) and the mean number of International Society for Heart and Lung Transplantation grade 2 or higher endomyocardial biopsy specimens per patient (0.3) were lower compared with those observed during the 6-month pre-actinomycin D period (1.6 and 2.6, respectively). By 6 months after initiation of actinomycin D, all seven patients were receiving lower daily maintenance doses of corticosteroids. The mean total corticosteroid dose after actinomycin D administration per patient per month (615 +/- 177 mg) was significantly lower than the pre-actinomycin D dose (1012 +/- 347 mg; p = 0.019). No patient had significant adverse effects.


CONCLUSIONS
Actinomycin D is an effective immunosuppressive agent for prevention of recurrent cellular or humoral rejection after cardiac allograft rejection. The corticosteroid sparing effect of actinomycin D may be of particular benefit.
DiSalvo
T G
TG
Massachusetts General Hospital Heart Failure and Cardiac Transplantation Center, Boston 02114, USA.
Narula
J
J
Cosimi
A B
AB
Keck
S
S
Dec
G W
GW
Semigran
M J
MJ
D001706:Biopsy; D003609:Dactinomycin / Q000008:administration & dosage*; D004699:Endocardium / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000473:pathology / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D003609:Dactinomycin; D011241:Prednisone