Outcome after steroid withdrawal in heart transplantation.
BACKGROUND
There is a lack of consensus and insufficient data to assess the impact of late steroid withdrawal after heart transplantation (HTx). The aim of the study was to investigate the security and feasibility of corticosteroid withdrawal at 1 year after transplantation.


RESULTS
Steroid withdrawal was attempted after at least 12 months of treatment in 86 HTx patients who fulfilled the criteria. At 1 and 3 months after drug discontinuation, patients underwent 2 endomyocardial biopsies (EMB). After a mean follow-up of 25 +/- 13 months, 63% of the patients remained steroid free. In 30 patients (35%) corticosteroids were reinitiated, in 15 cases because of acute rejection (7%), 5 (6%) because of worsening renal function, 5 (6%) because of malignancy, 3 (4%) because of adverse effects of immunosuppressive drugs, and 2 because of severe allograft coronary artery disease. Four patients (5%) died after drug discontinuation. There was a significant decrease in total cholesterol (198 +/- 35 to 181 +/- 38 mg/dL; P < .001) and low-density lipoprotain (LDL) cholesterol levels (113 +/- 30 to 105 +/- 30 mg/dL; P < .001). There were no differences in mortality between patients with and without corticosteroids.


CONCLUSIONS
Steroid withdrawal is feasible and safe in HTx patients. In our study, it was successfully maintained in 63% of the patients. EMB is helpful to identify patients with acute rejection at 1 and 3 months after withdrawal. Short- to mid-term metabolic benefits are significant reductions in serum total and LDL cholesterol.
Castel
M A
MA
Thorax Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain. macastel@clinic.ub.es
Vallejos
I
I
Ramos
P
P
Arias
A
A
Bravo
C
C
Ferrero
M
M
Rivero
D
D
Sionis
A
A
Pérez-Villa
F
F
Roig
E
E
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000401:mortality; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D018579:Patient Selection; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology; D015996:Survival Rate; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D008078:Cholesterol, LDL; D002784:Cholesterol