title: Treatment of persistent rejection with methotrexate in stable patients submitted to heart transplantation.
abstract: OBJECTIVE
  To evaluate the use of methotrexate for the treatment of recurrent rejection in heart transplant recipients.
  
  
  METHODS
  We studied 6 patients submitted to heart transplantation that showed rejection grade >/= 3A (ISHLT) in two consecutive endomyocardial biopsy specimens. The dose was 11.26+/-3.75 mg/week. The evaluated data were: ventricular function, endomyocardial biopsy, white cell count and number of rejection episodes before and after methotrexate administration.
  
  
  RESULTS
  There was a reduction in the number of rejection episodes (5.17+/-1.47 before methotrexate; 2.33+/-1.75 after 6 months and 3.17+/-2.99 after 12 months of treatment, p=0. 0193). The ventricular function was normal with ejection fraction of 76.5+/-4.80 before and 75.6+/-4.59 after methotrexate (p=0.4859). One patient did not finish the treatment because he showed signs of rejection associated with severe pericardial effusion. Five patients had a reduction in the white cell count (8,108+/-23.72 before and 5650+/-1350 after methotrexate, p=0.0961). One pulmonary infection with complete resolution after antibiotic treatment was observed.
  
  
  CONCLUSIONS
  Methotrexate in low doses is an effective adjunct therapy in the treatment of recurrent rejection after heart transplantation.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, 05403-000, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Bacal
authors.forename: V C
authors.initials: VC
authors.lastname: Veiga
authors.forename: A I
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: G
authors.initials: G
authors.lastname: Bellotti
authors.forename: E A
authors.initials: EA
authors.lastname: Bocchi
authors.forename: N A
authors.initials: NA
authors.lastname: Stolf
authors.forename: J A
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000188:drug therapy*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007958:Leukocyte Count; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate