Document Detail


Increased rejection rates in cardiac transplant associated with dexamethasone.
MedLine Citation:
PMID:  18243261     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Peri-operative immunosuppression in cardiac transplantation includes the use of intravenous methylprednisolone. During a national shortage, intravenous dexamethasone was substituted for methylprednisolone at standard equivalencies. Methylprednisolone and dexamethasone are used interchangeably in many clinical settings; however, their equivalency has not been demonstrated. METHODS: Forty-two consecutive cardiac transplant patients were studied retrospectively. All patients received standard triple immunosuppression. Eighteen patients received dexamethasone and 24 methylprednisolone. Twelve patients were included for comparison after the methylprednisolone shortage resolved. Endomyocardial biopsy (EMB) results graded as > or =1B (ISHLT classification) were considered positive for acute cellular rejection. RESULTS: More patients who received dexamethasone as induction had cellular rejection (12/17; (70%) vs. 14/33; (42%); p=0.05). Four patients were excluded because of deaths unrelated to cardiac function. The increased rate of rejection seen during dexamethasone substitution declined after reinstitution of methylprednisolone (p=0.05). CONCLUSIONS: Peri-operative high-dose dexamethasone in cardiac transplants was associated with higher rates of acute cellular rejection. The equivalencies of dexamethasone and methylprednisolone differ from accepted standards when used in pulse doses. Peri-operative use of glucocorticoids may rely on mechanisms that are different from those considered in the standard equivalency measures. Pulse doses of dexamethasone and methylprednisolone in transplantation may not be interchangeable at standard equivalencies.
Authors:
Adam B Cochrane; Aliya N Husain; Allen S Anderson; Antony Y Kim; Savitri E Fedson
Publication Detail:
Type:  Journal Article     Date:  2007-12-28
Journal Detail:
Title:  Steroids     Volume:  73     ISSN:  0039-128X     ISO Abbreviation:  Steroids     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-02-25     Completed Date:  2008-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0404536     Medline TA:  Steroids     Country:  United States    
Other Details:
Languages:  eng     Pagination:  441-8     Citation Subset:  IM    
Affiliation:
Department of Pharmacology, University of Chicago, Chicago, IL 60637, United States.
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MeSH Terms
Descriptor/Qualifier:
Adult
Dexamethasone / administration & dosage,  adverse effects*
Female
Glucocorticoids / administration & dosage,  adverse effects
Graft Rejection / chemically induced*
Heart Transplantation / immunology*
Humans
Immunosuppression / adverse effects,  methods
Male
Methylprednisolone / administration & dosage,  adverse effects
Middle Aged
Retrospective Studies
Chemical
Reg. No./Substance:
0/Glucocorticoids; 50-02-2/Dexamethasone; 83-43-2/Methylprednisolone

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


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