Pulsed Steroids for Treatment of Cardiac Rejection After Transplantation What Dosage Is Necessary?

For treatment of biopsy-proven rejections after cardiac transplantation, pulsed steroids of 1,000 mg methylprednisolone/day for 3 days have been conventionally used. This regimen results in severe side effects, both metabolically and with respect to the risk of infection. In a prospective and a more comprehensive retrospective clinical study, we investigated the effect of a 50% reduction in that dosage. A total of 512 positive biopsies were analyzed in 128 patients. Of these, 64 patients (120 biopsies) in group 1 received 500 mg/day for 3 days while the remaining 107 patients (392 biopsies) in group 2 were treated with 1,000 mg/day for 3 days (43 patients belonged to both groups 1 and 2). Response to treatment was assessed by control biopsies in a standardized time period until the next biopsy-proven rejection (maximum of 10 biopsies). The results in short and longer follow-up periods, considering the incidence and a newer empirical numerical grading scale, have demonstrated clearly comparable effects on myocardial histology. Reduced dosage of steroids is feasible and safe, and a decrease in steroid-related side effects can be achieved without jeopardizing the graft.