Prednisone Wean After Dual Heart and Kidney Transplantation: Is There a Risk?
Cedars-Sinai Heart Institute, Los Angeles, CA.
Meeting: 2016 American Transplant Congress
Abstract number: B162
Keywords: Heart/lung transplantation, Immunosuppression
Session Information
Session Name: Poster Session B: Hearts and VADs in Depth - The Force Awakens
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: Corticosteroids are the cornerstone of immunosuppressive therapy post transplant (Tx)but there are deleterious effects of long-term use. A protocol of corticosteroid weaning starting 6-12 months is effective post heart Tx but the utility in dual heart-kidney Tx is not clear. We sought to evaluate the success of prednisone weaning in heart-kidney Tx recipients at our center.
Methods: We evaluated 335 consecutive patients transplanted between 2010 and 2013, 169 of whom were initiated on steroid withdrawal. Patients were divided into heart alone Tx and heart-kidney Tx groups. Outcomes assessed included the success of the corticosteroid wean and freedom from any rejection (heart or kidney) during the wean. Other outcomes were subsequent 1-year survival and freedom from corticosteroid wean failure (restart of corticosteroid use during 1-year followup), cardiac allograft vasculopathy (CAV) as defined by stenosis ≥ 30%, Non-Fatal Major Adverse Events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke) and any-treated rejection.
Results: There was no significant difference between the heart-kidney Tx and heart Tx groups for initial corticosteroid wean success, subsequent 1-year survival, CAV, NF-MACE, and any-treated rejection. There was no difference in freedom from any rejection (heart or kidney) during the wean.
| Endpoints | Dual Heart-Kidney Transplant (n=10) | Heart Transplant Only (n=159) | P-Value |
| Initial Success of Corticosteroid Wean | 80.0% (8/10) | 84.9% (135/159) | 0.653 |
| Freedom from Any Rejection (Heart or Kidney) During Corticosteroid Wean | 100.0% | 97.5% | 0.782 |
| Subsequent 1-Year Survival Post Corticosteroid Wean | 100.0% | 98.5% | 0.737 |
| Subsequent Restart of Corticosteroid Use Any Time Post-Transplant | 20.0% (2/10) | 5.2% (7/135) | 0.119 |
| Subsequent 1-Year Freedom from CAV Post Corticosteroid Wean | 87.50% | 91.60% | 0.604 |
| Subsequent 1-Year Freedom from NF-MACE Post Corticosteroid Wean | 100.00% | 98.50% | 0.728 |
| Subsequent 1-Year Freedom from Cardiac Rejection Post Corticosteroid Wean | 100.00% | 98.50% | 0.737 |
Conclusion: There appears to be no difference in the success rate or risk of prednisone wean for heart-kidney Tx recipients when compared to heart Tx recipients. Longer followup is needed for further assessment of patient risk with corticosteroid withdrawal.
CITATION INFORMATION: Chang D, Patel J, Kittleson M, Aintablian T, Czer L, Ramzy D, Kobashigawa J. Prednisone Wean After Dual Heart and Kidney Transplantation: Is There a Risk? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Chang D, Patel J, Kittleson M, Aintablian T, Czer L, Ramzy D, Kobashigawa J. Prednisone Wean After Dual Heart and Kidney Transplantation: Is There a Risk? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/prednisone-wean-after-dual-heart-and-kidney-transplantation-is-there-a-risk/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress