Survival and incidence of acute rejection in heart transplant recipients undergoing successful withdrawal from steroid therapy

Sirolimus Conversion After Heart Transplant: Risk Factors for Acute Rejection and Predictors of Renal Function Response

“…However, these data are based on only three patients, two of whom developed BCAR. In a cohort of cardiac transplant recipients undergoing withdrawal from steroid therapy, black race was associated with shorter 5-year survival rate but was not evaluated for association with BCAR rates (17). In a separate study evaluating the use of induction therapy within 48 h of cardiac transplantation, black race was identified as a risk factor for fatal rejection (29).…”

“…The incidence of BCAR was defined in the study protocol as a secondary end point. Potential predictors for the occurrence of BCAR were evaluated based on previously reported literature (17)(18)(19). Thirteen variables were tested: baseline GFR, age, race, years since transplant, sex, history of rejection, initial CNI, use of steroids, azathioprine, MMF, mycophenolate sodium, sirolimus trough level and time-normalized trough sirolimus concentration (C min-TN ).…”

Transcriptional Signals of T-cell and Corticosteroid-sensitive Genes Are Associated With Future Acute Cellular Rejection in Cardiac Allografts

“…This is significant in the early post-transplant period as corticosteroids are the principle immunosuppressive agent subject to active dose reduction within the first 6 months after cardiac transplantation. 1 Decreased relative expression of five additional genes, IL1R1, TSC22D3, FKBP5, THBS1 and CD163, was observed in the rejection case group, each of which is known to be induced by corticosteroids. [12][13][14][15] This indicates a role for lower functional responsiveness to corticosteroids in the increased risk of cardiac rejection.…”

“…1,2 Endomyocardial biopsy provides assignment of rejection grades based on the extent and distribution of leukocyte infiltrates, and evidence of accompanying myocyte damage. [3][4][5] No compelling data exist to demonstrate the utility of endomyocardial biopsy in predicting rejection of a future biopsy sample.…”

Current Trends in Heart Transplantation

“…Other interesting trends in immunosuppression include the development of steroid-free maintenance immunosuppression protocols (37,38). Reports of early steroid tapering have been published, and the overall trend is to taper offs teroids in the first 4-12 months after transplantation if possible.…”