Adjuvant treatment with ursodeoxycholic acid may reduce the incidence of acute cardiac allograft rejection.
BACKGROUND
The nontoxic bile acid, ursodeoxycholic acid (UDCA), is an effective drug for the treatment of different cholestatic conditions. Furthermore, an immunomodulatory capacity of UDCA has been reported in vitro, as well as in vivo, in different immune-mediated liver diseases and after liver transplantation.


METHODS
In this retrospective study, the influence of UDCA on heart transplant rejection was investigated in 21 cardiac allograft recipients receiving UDCA for cyclosporine-induced cholestasis (500 mg administered twice daily, start of therapy within the first postoperative month, duration >8 weeks). Thirty-one patients not receiving UDCA served as control subjects. All patients received triple-maintenance immunosuppression (cyclosporine, azathioprine, prednisolone). For quantitative comparison of rejection severity, the following score was applied: 0, no specific therapy; 1, temporary increase in oral steroids; 2, intravenous steroids; 3, ATG or OKT3 therapy.


RESULTS
During the first 6 postoperative months, the number of acute rejection episodes requiring specific anti-rejection therapy was significantly lower in the UDCA group as compared with control subjects (1.38 +/- 1.36 vs 2.74 +/- 1.83 rejection episodes per patient, p = 0.005). The cumulative score was significantly lower in the UDCA group as compared with control subjects (2.38 +/- 2.29 vs 5.06 +/- 3.61, p = 0.004).


CONCLUSIONS
These initial data indicate a beneficial effect of adjuvant UDCA treatment in the early phase after heart transplantation probably related to immunomodulating properties of UDCA, which may be used therapeutically after organ transplantation.
Bährle
S
S
Department of Cardiology, University of Heidelberg, Germany.
Szabó
G
G
Stiehl
A
A
Theilmann
L
L
Dengler
T J
TJ
Zimmermann
R
R
Kübler
W
W
D000208:Acute Disease; D002779:Cholestasis / Q000139:chemically induced / Q000188:drug therapy; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid; D016572:Cyclosporine