HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ratkovec, R. M. Articles by Menlove, R. L. Search for Related Content PubMed PubMed Citation Articles by Ratkovec, R. M. Articles by Menlove, R. L.

The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 6-12, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Influence of corticosteroid-free maintenance immunosuppression on allograft coronary artery disease after cardiac transplantation

RM Ratkovec, RB Wray, DG Renlund, JB O'Connell, MR Bristow, WA Gay Jr, SV Karwande, DB Doty, RC Millar and RL Menlove
Utah Transplantation Affiliated Hospitals, Cardiac Transplant Program, Salt Lake City.

Although the etiology of allograft coronary artery disease, a major limiting factor in long-term survival after cardiac transplantation, is poorly understood, it is undoubtedly in part immune mediated and not detected by routine endomyocardial biopsy. Therefore it is possible that withdrawal of maintenance corticosteroids, although providing other short- and long-term benefits, could increase the prevalence of allograft coronary artery disease by permitting undetected immune- mediated vascular injury to occur. To assess whether corticosteroid- free maintenance immunosuppression increased the prevalence of allograft coronary artery disease, we reviewed serial angiograms of 102 patients (49% not receiving corticosteroid maintenance therapy) who underwent heart transplantation after March 7, 1985. Multiple variables including serum cholesterol, recipient and donor age, sex, blood pressure, rejection frequency and severity, early rejection prophylaxis protocol (polyclonal versus monoclonal T-cell agents), and corticosteroid use were examined in relation to allograft coronary artery disease by univariate and multivariate analyses. Allograft coronary artery disease was identified in 21 patients (seven severe, four moderate, and 10 mild). The prevalence by Kaplan-Meier life-table analysis was 17% at 1 year and 25% at 2 years. No further allograft coronary artery disease was detected among patients undergoing angiography at three years. Increased allograft coronary artery disease was not noted in patients withdrawn from maintenance corticosteroids when compared with their corticosteroid-requiring counterparts. In fact, with each 1 gm increment in cumulative corticosteroid use, a slightly increased risk (1.04, p less than 0.05) of allograft coronary artery disease was noted (Cox regression model). None of the other variables correlated with the prevalence of allograft coronary artery disease. Thus withdrawal of maintenance corticosteroids is not associated with an increased risk of early allograft coronary artery disease and minimization of corticosteroids may lead to a decreased long-term incidence of coronary artery disease in cardiac transplant recipients.

This article has been cited by other articles:

				S Fraund, K Pethig, U Franke, T Wahlers, W Harringer, J Cremer, H-G Fieguth, P Oppelt, and A Haverich Ten year survival after heart transplantation: palliative procedure or successful long term treatment? Heart, July 1, 1999; 82(1): 47 - 51. [Abstract] [Full Text] [PDF]

				J. Botas, F. J. Pinto, A. Chenzbraun, D. Liang, J. S. Schroeder, S. N. Oesterle, E. L. Alderman, R. L. Popp, and A. C. Yeung Influence of Preexistent Donor Coronary Artery Disease on the Progression of Transplant Vasculopathy : An Intravascular Ultrasound Study Circulation, September 1, 1995; 92(5): 1126 - 1132. [Abstract] [Full Text]

				W. M. DeCampli, H. Luikart, S. Hunt, and E. B. Stinson Characteristics of patients surviving more than ten years aftercardiac transplantation J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1103 - 1115. [Abstract] [Full Text]

				G. L. Winters, E. Loh, and F. J. Schoen Natural History of Focal Moderate Cardiac Allograft Rejection : Is Treatment Warranted? Circulation, April 1, 1995; 91(7): 1975 - 1980. [Abstract] [Full Text]