Late Steroid Withdrawal After Heart Transplantation and Incidence of Acute Rejection

Crespo-Leiro, María G.; Paniagua, María; Franco, Rocío Tovar; Marzoa, R.; Grille, Z.; Naya, C.; Barge, Eduardo; Rı́os, Ramón; Rodriguez, J.A; Calviño, Ramón; Cuenca, José; Castro‐Beiras, Alfonso

doi:10.1016/j.transproceed.2007.07.065

Cited by 9 publications

(2 citation statements)

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“…Approximately half of the steroid-free patients required institution of chronic steroids due to rejection however. More recently, Crespo-Leiro et al reported on 24 stable heart transplant recipients who had not had any acute allograft rejection for at least 4 years and were weaned from corticosteroids in a study [ 12 ]. Of concern, 25% of the patients (6/24) developed ISHLT grade 2R or greater rejection which necessitated treatment with intravenous steroids, although no episode was fatal.…”

Section: Discussionmentioning

confidence: 99%

“…While some early studies described the feasibility of steroid weaning [ 6 – 10 ], the idea has not been embraced, and International Society for Heart and Lung Transplantation (ISHLT) registry data indicates that more than 60% of patients are chronically maintained on corticosteroids [ 11 ]. The fear of allograft rejection and the concern about “unmasking” occult adrenal insufficiency are the main clinical reasons that more patients are not routinely discontinued from steroid therapy [ 7 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level

Baran

Rosenfeld

Zucker

2018

Journal of Transplantation

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Background Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol < 8 micrograms/deciliter were assigned to a “maintenance” group and the others were assigned to the weaning group and steroids were tapered off over 4–6 weeks. Patients were monitored on subsequent office visits for adrenal insufficiency and allograft rejection. Results Thirty-one patients were enrolled (6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2 ± 4 years for the weaning group and 9.0 ± 4.9 years in the maintenance group (p = 0.6). No cases of rejection were noted, nor did any patient resume steroid treatment following discontinuation. Conclusion Steroids can be safely discontinued in stable heart transplant patients with an AM serum cortisol ≥ 8 micrograms/deciliter with appropriate outpatient follow-up. In this study, no patient suffered late rejection or clinically noted adrenal insufficiency.

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Section: Discussionmentioning

confidence: 99%