title: Diagnosis and treatment of steroid resistant cellular rejection in heart transplant recipients--single center experience.
abstract: OBJECTIVE
  Aim of the study was to assess frequency and risk factors of steroid resistant cellular rejection (SRR) in heart transplant recipients, to determine methods of its treatment, and to evaluate influence of steroid resistant rejection and method of its treatment on short- and long-term results.
  
  
  METHODS
  All pts. received cyclosporine-A, azathioprine and prednisone. Biopsy results > or = 3A (ISHLT) were considered a significant rejection, requiring treatment with 1 g i.v. methylprednizolone for 3 days followed by oral prednisone. SRR was recognized in case of biopsy-proven progression of rejection, lack of improvement in 2 consecutive biopsies, or increasing hemodynamic compromise despite treatment of biopsy-proven rejection. 146 pts. eligible for the study were divided into: study group--15 pts. with SRR (10%), and control group--131 pts. SRR was treated with: cytolytic therapy--ATG (10 pts.), mycophenolate mofetil (3 pts.) or steroids (2 pts.). Number of biopsies > or = 3A, cumulative biopsy score, average biopsy result, effectiveness of SRR treatment, side effects of therapy, and survival were analysed.
  
  
  RESULTS
  All parameters characterizing rejection were significantly higher in the study group. No risk factors of SRR were found. In 6 pts. with SRR and hemodynamic compromise (all treated with ATG) improvement was observed in 4 pts, while death occurred in 2 pts. There were no deaths in pts. without hemodynamic compromise--none of 3 methods of treatment was superior, however ATG increased the infection risk. Survival in the 1st year was significantly lower in the study group (67% vs. 89% in the control group).
  
  
  CONCLUSIONS
  SRR is recognized in about 10% of heart transplant recipients, increasing risk of death in the 1st year after surgery. Cytolytic therapy increases risk of infection, and should be avoided in pts. without hemodynamic compromise.
authors.affiliation: Dept. of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland. zaklimed@poczta.onet.pl
authors.forename: Michał
authors.initials: M
authors.lastname: Zakliczyński
authors.forename: Jerzy
authors.initials: J
authors.lastname: Nozyński
authors.forename: Helena
authors.initials: H
authors.lastname: Zakliczyńska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kozłowska
authors.forename: Iwona
authors.initials: I
authors.lastname: Trzcińska
authors.forename: Marta
authors.initials: M
authors.lastname: Szewczyk
authors.forename: Dominika
authors.initials: D
authors.lastname: Konecka-Mrówka
authors.forename: Jerzy
authors.initials: J
authors.lastname: Foremny
authors.forename: Marcin
authors.initials: M
authors.lastname: Swierad
authors.forename: Roman
authors.initials: R
authors.lastname: Przybylski
authors.forename: Halina
authors.initials: H
authors.lastname: Pisarska
authors.forename: Jacek
authors.initials: J
authors.lastname: Wojarski
authors.forename: Jacek
authors.initials: J
authors.lastname: Durmała
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D004351:Drug Resistance; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid