Abstract
A204 Background: Corticosteroids are routinely used in almost all immunosuppressive protocols after heart transplantation (HTx). The multiple adverse effects of long-term glucocorticoid therapy could lead to significant post-HTx morbidity. That morbidity may be reduced by withdrawing steroids in selected patients. Aims: The study evaluates the impact of steroid weaning on incidence of acute rejection and occurrence of corticosteroid metabolic side effects in patients after HTx. Methods: The records of 78 patients (10 women) more than 3 months after HTx (median 63 months) were retrospectively reviewed. Standard triple-drug immunosuppression was initially used. The cohort of patients was divided into two groups according to prednison therapy – group P (n=53) was chronically treated with steroids, in group NON-P (n=25) prednison was withdrawn at an average of 48 months after HTx. Incidence of acute rejection and steroid-related metabolic complications (obesity, hyperlipidemia, glucose intolerance) were compared between two groups. Changes of selected parameters were analysed before and after steroid weaning within the group NON-P and during the same follow-up period within the group P. Results: The mean daily dose of prednison in group P was 5,5 ± 3,2 mg. Rejection score and occurrence of obesity, hyperlipidemia and diabetes were similar in both groups before immunosuppression was changed. Incidence of acute rejection was not higher after cessation of steroids. Patients in NON-P group significantly reduced the weight (mean decline 4 kg; p<0,005), body mass index (29,2 vs 28,3, resp.; p<0,05), total cholesterol (5,4 mmol/l vs 4,8 mmol/l, resp.; p<0,005) and triglycerides (2,7 mmol/l vs 2,4 mmol/l, resp.; p<0,05) after prednison withdrawal. Changes of these findings were not observed in group P during the follow–up. Conclusion: Weaning of steroids even late after HTx has positive metabolic effect in HTx recipients without increased risk of acute rejection.
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