Is it possible to reduce the number of endomyocardial biopsies with new immunosuppressive drugs?
BACKGROUND
Using previous immunosuppressive regimens the considerable number of rejections of heart transplantations required routine surveillance myocardial biopsies, particularly during the early months. More effective immunosuppressive regimens would probably allow routine biopsies to be reduced. Our objectives were to assess the incidence of and the time to rejection with a new immunosuppressive protocol, considering the possibility of reducing the number of routine biopsies.


METHODS
We undertook a retrospective study of patients who had undergone heart transplantation from January 2002 to August 2005 and who received induction therapy with Daclizumab (two doses) and maintenance therapy with tacrolimus + mycophenolate + low doses of steroids.


RESULTS
Among 42 patients, 13 (31%) showed myocardial rejection in the first 3 months. All episodes were grade 3A and none had hemodynamic consequences. After 3 months, three patients (7.1%) experienced 3A rejection and 1 (2.4%), grade 4 acute rejection after ceasing medical treatment. Each episode of rejection was predictable, either owing to reduction in immunosuppression therapy or to a previous history of rejection.


CONCLUSIONS
The majority of rejection episodes occur in the first 3 months posttransplantation. After that time, the incidence of rejection is less and clinically predictable. Therefore, surveillance biopsies should be limited to the first 3 months, and performed later either in symptomatic patients (with a history of previous rejection) or in those whose immunosuppressive therapy needs to be reduced.
Lage
E
E
Department of Cardiology and Cardiac Surgery, Hospital Virgen del Rocío, Seville, Spain. ernesto.lage.sspa@juntadeandalucia.es
Ballesteros
S
S
Mogollón
M V
MV
Ordóñez
A
A
Gómez
S
S
Hernández
A
A
Hinojosa
R
R
D001706:Biopsy / Q000706:statistics & numerical data*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis
D007166:Immunosuppressive Agents