Steroid-free Immunosuppression in Heart-Kidney Transplant Patients: Is It Safe?

R. Skorka, J. Patel, M. Kittleson, N. Patel, T. Singer-Englar, A. Velleca, B. Azarbal, D. Chang, E. Kransdorf, L. Czer, D. Megna, J. A. Kobashigawa

Cedars-Sinai Smidt Heart Institute, Los Angeles, CA

Meeting: 2021 American Transplant Congress

Abstract number: 43

Keywords: Glomerular filtration rate (GFR), Outcome, Rejection

Topic: Clinical Science » Heart » Heart and VADs: All Topics

Session Information

Session Name: Heart: Triple "D" in Heart Transplantation: DCD, Dual-Organ and Declined Hearts

Session Type: Rapid Fire Oral Abstract

Date: Saturday, June 5, 2021

Session Time: 4:30pm-5:30pm

Presentation Time: 4:30pm-4:35pm

Location: Virtual

*Purpose: Simultaneous heart and kidney transplantation (sHKTx) has increased in numbers over the past 10 years. There are reports that the kidney protects the heart from rejection. Currently, it is common to wean off prednisone after 6 months post-transplant in patients who have had no rejection episodes. This practice has not been performed routinely in sHKTx. Therefore, we reviewed our sHKTx patient population for those patients taken off prednisone compared to those left on prednisone and assessed their subsequent outcome.

*Methods: Between 2010 and 2018, we assessed 50 sHKTx patients. 13 of these patients were weaned off prednisone within the first year after transplantation and 37 patients remained on prednisone. The endpoints included subsequent 1-year survival, 1-year freedom from cardiac allograft vasculopathy (CAV, as defined by stenosis ≥30% by angiography), and subsequent 1-year freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Creatinine and glomerular filtration rate (GFR) were used to assess renal function pre- and post-prednisone wean.

*Results: Patients who were weaned from prednisone compared to those that were not exhibited similar subsequent 1-year survival (100% vs. 94.5%), freedom from CAV (92.3% vs. 100%), and freedom from ACR (100% vs. 100%) and AMR (100% vs. 97.3%). In addition, renal function was not affected by the prednisone wean. (See table)

*Conclusions: Steroid-free immunosuppression appears safe in sHKTx patient. Larger number of patients will be needed to confirm these findings.


Endpoints	sHKTx Patients Weaned Off Prednisone (n=13)	sHKTx Patients Not Weaned Off Prednisone (n=37)	P-value
Creatinine @ Start of Wean	1.34 ± 0.40	1.47 ± 0.87	0.597
Creatinine @ End of Wean	1.29 ± 0.25	1.27 ± 0.86	0.937
GFR @ Start of Wean	61.23 ± 21.84	64.57 ± 30.55	0.719
GFR @ End of Wean	61.00 ± 21.78	64.31 ± 30.40	0.721

To cite this abstract in AMA style:

Skorka R, Patel J, Kittleson M, Patel N, Singer-Englar T, Velleca A, Azarbal B, Chang D, Kransdorf E, Czer L, Megna D, Kobashigawa JA. Steroid-free Immunosuppression in Heart-Kidney Transplant Patients: Is It Safe? [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/steroid-free-immunosuppression-in-heart-kidney-transplant-patients-is-it-safe/. Accessed November 21, 2024.

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