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 March 6, 2021.
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