Document Detail

Benefits of avoidance of induction immunosuppression in heart transplantation.
MedLine Citation:
PMID:  2671316     Owner:  NLM     Status:  MEDLINE    
Current immunosuppression protocols in heart transplantation commonly employ an inductive phase preoperatively, which often is followed by triple therapy (azathioprine, cyclosporine, and prednisone). From 1981 to June 1987, 119 heart transplants were performed in 114 patients. Group I (n = 19) received cyclosporine preoperatively and postoperatively, as well as steroid intraoperatively and postoperatively. Group II (n = 100) received antilymphocyte globulin postoperatively and interval cyclosporine orally 5 to 7 days postoperatively when the antilymphoblast globulin was discontinued. Methylprednisolone was given intraoperatively, and 1 mg/kg was given postoperatively. Steroid was tapered to 20 mg/day within 4 weeks. Cyclosporine was removed from the early postoperative regimen to reduce the deleterious renal effects. Steroid was used in low doses and tapered quickly to lessen steroid-related complications. There was one cyclosporine-related kidney failure in group I and none in group II. In no patient was cyclosporine discontinued because of adverse effects. The rate of rejection remains acceptable. There have been eight deaths as a result of rejection (three in group I and five in group II). Three patients have died of infection (one in group I and two in group II). Since January 1987 no postoperative protective isolation has been used. Overall survival is 77%, and no patient has exhibited late coronary atherosclerosis on follow-up coronary angiography. The regimen of immunosuppression that has evolved is safe and effective and has long-term benefits.
A H Menkis; F N McKenzie; D Thomson; M Jones; P Pflugfelder; W J Kostuk; C R Stiller
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of heart transplantation     Volume:  8     ISSN:  0887-2570     ISO Abbreviation:  J Heart Transplant     Publication Date:    1989 Jul-Aug
Date Detail:
Created Date:  1989-09-27     Completed Date:  1989-09-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8604172     Medline TA:  J Heart Transplant     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  311-4     Citation Subset:  IM    
University Hospital, University of Western Ontario, London, Canada.
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MeSH Terms
Antilymphocyte Serum / therapeutic use
Cyclosporins / therapeutic use
Drug Administration Schedule
Drug Therapy, Combination
Graft Rejection*
Heart Transplantation*
Immunosuppression / methods*
Immunosuppressive Agents / therapeutic use*
Intraoperative Care
Methylprednisolone / therapeutic use
Prednisone / therapeutic use
Preoperative Care
Retrospective Studies
Reg. No./Substance:
0/Antilymphocyte Serum; 0/Cyclosporins; 0/Immunosuppressive Agents; 53-03-2/Prednisone; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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