title: Steroid-free and steroid withdrawal protocols in heart transplantation: the review of literature.
abstract: Corticosteroids (CSs) are still the mainstay of induction, rescue, and maintenance in heart transplantation (HTx). However, their use is associated with significant and well-documented side effects usually related to the dose administered and the duration of therapy. Moreover, CSs interfere with the recipient's quality of life and with the active process of graft tolerance. Physicians have been exploring ways to avoid or reduce CSs in association with other immunosuppressive drugs, minimizing side effects and costs. The regimens are classified as steroid-free or steroid withdrawal protocols. The studies analyzed in this review come to similar conclusions as benefits and adverse consequences: steroid-free protocols should be advisable and mandatory in pediatric patients, insulin-dependent diabetes mellitus (IDDM), presence of infection, familial metabolic disorders/obesity, severe osteoporosis, and in the elderly. On the other hand, steroid withdrawal can be successfully achieved in 50-80%, with late better than early withdrawal, no increase in rejection-related mortality, no adverse impact on survival, and probably a better quality of live. Safety and efficacy can certainly be improved by an individualized approach to the transplant recipient.
authors.affiliation: Department of Experimental and Clinical Medicine, Medical School, University of Udine, Udine, Italy; SOC Institute of Clinical Pharmacology, University-Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Baraldo
authors.forename: Giorgia
authors.initials: G
authors.lastname: Gregoraci
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control*; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014181:Transplantation Immunology; D023001:Transplantation Tolerance / Q000187:drug effects; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents
keywords: heart transplantation; steroid minimization; steroid withdrawal; steroid-free