Should moderate acute rejection of a cardiac transplant graft be treated?
Clin Transplant
; 16(3): 217-21, 2002 Jun.
Article
de En
| MEDLINE
| ID: mdl-12010147
ABSTRACT
UNLABELLED Histologically proven, moderate acute rejection after orthotopic heart transplantation (OHT) is commonly treated with intravenous steroids. This regimen may result in severe metabolic and infectious side-effects. The purpose of this study was to assess and compare outcomes in treated (T) versus not treated (N-T) biopsy proven 3A rejection episodes in cardiac transplant recipients. METHODS:
A retrospective analysis was conducted to identify all biopsy proven 3A rejection episodes that occurred over the time period 1995-2000 in patients (patients) >or= 6 months after OHT (n=48 episodes in 35 patients). Of the 48 episodes, 19 were N-T and 29 were T. Decision to treat 3A rejection was based on time after transplant, haemodynamic and/or clinical compromise and left ventricular (LV) dysfunction measured by 2D echo. Most N-T episodes received an increase in background immunotherapy.RESULTS:
Time from transplant to index 3A episode in N-T patients was 4.2 versus 2.7 yr for the T patients (p=0.06). There were no differences seen between T and N-T groups for the first and second post-3A biopsy results or LV function post-3A. Presence of coronary disease or death were not different between groups. Of the 29 patients with T episodes, no differences in outcomes (death, first and second post-3A biopsy score, coronary disease, myocardial infarction, or LV function) were seen based on use of treatment with intravenous versus oral steroid.CONCLUSION:
In patients more than 6 month after OHT, there were no differences in outcomes (ongoing rejection or LV function) between N-T episodes of 3A rejection and T episodes. In T patients the use of oral steroids was equally as effective for treatment of 3A episodes as intravenous steroids.
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Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Transplantation cardiaque
/
Rejet du greffon
/
Immunosuppresseurs
Type d'étude:
Observational_studies
/
Prognostic_studies
Limites:
Adolescent
/
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
Clin Transplant
Sujet du journal:
TRANSPLANTE
Année:
2002
Type de document:
Article
Pays d'affiliation:
Canada