Abstract
Corticosteroid withdrawal after heart transplantation is limited to select immune-privileged patients but it is not known whether this predisposes patients to a higher risk for sensitization. A total of 178 heart transplant recipients had panel-reactive antibody (PRA) measurements at transplant and every 6months and were monitored for rejection with protocol endomyocardial biopsies. Corticosteroid withdrawal was initiated at 6months post-transplant in select patients. Patients successfully weaned off prednisone (SPW; n=103) had lower PRA compared to those maintained on prednisone (MP; n=51) at pretransplant (34% vs 63%), 6months (18% vs 49%), 12months (19% vs 51%), and 18months (15% vs 47%) after transplant (P<.05). Among 68 nonsensitized patients at transplant in the SPW group, seven (10%) developed de novo PRA at 12months, compared to four of 19 (21%) of MP patients. Freedom from any treated rejection (97% vs 69% vs 67%), acute cellular rejection (100% vs 86% vs 71%), and antibody-mediated rejection (100% vs 88% vs 88%; all P≤.001) at 2years was higher in SPW compared to MP and those who failed prednisone wean, respectively. Few patients successfully weaned off prednisone after heart transplant develop de novo circulating antibodies but are not at increased risk for developing rejection.
Published Version
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