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Abstract
BACKGROUND Allergic reactions to systemically administered corticosteroids seem to be infrequent considering their extensive use. The aim of the study was to evaluate the IgE response in patients with immediate allergic reactions to methylprednisolone (MP). METHODS Four subjects who developed immediate reactions after MP administration and ten controls with good tolerance to MP administration were evaluated. Skin prick and intradermal testing were done using MP, hydrocortisone (HC), and dexamethasone (DX). If negative, a drug provocation test (DPT) was done to confirm the diagnosis and assess cross-reactivity. The in vitro IgE response was evaluated by the basophil activation test (BAT) and ImmunoCAP. RESULTS Three patients were diagnosed by the presence of a positive skin test in the immediate reading with MP, two by prick and one by intradermal testing, and one patient was skin test negative and diagnosed by DPT. All four patients had good tolerance to HC and DX. The BAT was positive for just MP in those patients with positive skin tests, with all patients being negative for HC and DX. Two patients were also ImmunoCAP positive to MP. CONCLUSIONS This study confirms the existence of immediate allergic reactions to MP and that some are mediated by specific IgE antibodies. Skin testing, ImmunoCAP and the BAT are useful to confirm the diagnosis.
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Affiliation(s)
- A Aranda
- Research Unit for Allergic Diseases, Carlos Haya Hospital, Málaga, Spain
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2
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Myśliwiec J, Kretowski A, Stepień A, Kinalska I. Serum Levels of Soluble TNFα Receptors (sTNFR1 and sTNFR2) During Corticosteroid Treatment in Patients with Graves' Ophthalmopathy. Immunol Invest 2009; 33:61-8. [PMID: 15015833 DOI: 10.1081/imm-120027685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED TNFalpha was shown to play an important role in the autoimmune inflammatory process of Graves' ophthalmopathy (GO). In our previous study we found no significant changes in serum TNFalpha levels in GO patients. The aim of the present study was to estimate an influence of corticosteroids on serum levels of TNFalpha receptors (sTNFR1 and sTNFR2) in GO patients and to assess their potential as a guideline of immunosuppressive therapy. We detected serum sTNFRI and sTNFR2 in three groups of subjects: 18 patients with clinical symptoms of ophthalmopathy [Clinical Activity Score (CAS) > or = 4, anamnesis of GO > or = 1 yr], 16 patients with Graves' disease without ophthalmopathy (Gd) and 14 healthy volunteers. Corticosteroid therapy consisted of intravenous infusions of methylprednisolone (MP) and subsequent treatment with oral prednisone (P). The serum samples were collected 24 hours before MP, 24 hours after MP, 14 days of treatment with prednisone and after the end of the corticosteroid therapy. The levels of serum sTNFR1 and sTNFR2 were determined by ELISA. Serum levels of sTNFR1 were significantly higher in GO individuals as compared to the control group (p < 0.01). We have found a significant decrease in sTNFR1 concentration in corticosteroid-respondent patients (satisfactory clinical effect, decrease of CAS > or = 1) as compared to the pretreatment values after MP treatment (p < 0.05) and after 14 days of prednisone (p < 0.01). There were significant differences in sTNFR2 level after MP treatment (p < 0.02) and after corticosteroid administration (p < 0.05) between responders and non-responders. Baseline values of sTNFRI in GO individuals were positively correlated with CAS (r = 0.6, p < 0.02). CONCLUSIONS TNFalpha acting through its receptors plays an important role in the pathogenesis of Graves' ophthalmopathy. Moreover, the beneficial influence of corticosteroids on the course of GO may be explained, at least in part, by an inhibition of sTNFR1 and sTNFR2. Measurement of soluble TNFalpha receptors might potentially serve as an indicator in prognostic estimation of corticosteroids' efficacy.
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Affiliation(s)
- Janusz Myśliwiec
- Department of Endocrinology, Diabetology and Internal Diseases, Medical Academy of Białystok, Białystok, Poland.
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4
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Affiliation(s)
- E Compalati
- Allergy & Respiratory Diseases, Department of Internal Medicine, Genoa, Italy
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5
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Abstract
Glucocorticoids (GCs) are known for their clinically useful effects in immunologic and inflammatory disorders. Although there is a huge volume of knowledge concerning the cellular and molecular effects of GCs, statements regarding their effects in multiple diseases at variable doses are not clear-cut owing to pharmacogenetic differences. The main actions of GCs in hematologic disorders have been related to their differentiation-inducing and apoptosis-inducing effects, but modification of several steps of the hematopoietic and/or immune pathway has also been reported. In our clinic, mega-dose methylprednisolone (MDMP) has been successfully used for treatment of different hematologic diseases, such as leukemias, bone marrow failure in aplastic anemia, hypoplastic anemia, myelodysplastic syndrome, neutropenia, autoimmune diseases, and in some congenital hereditary diseases. Both clinical and experimental studies in our department revealed that MDMP was more effective than conventional dose steroids. It is interesting that MDMP can be curative in some congenital hereditary diseases such as Diamond-Blackfan syndrome. However, more research is required to clarify their roles in biology, physiology, and molecular genetics.
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Affiliation(s)
- Sevgi Yetgin
- Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
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6
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Affiliation(s)
- Barton A Kamen
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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7
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Tsai CY, Tsai YY, Kuo HL, Chou CT. A woman with anti-histidyl-aminoacyl-tRNA synthetase (Jo-1 antibodies), myositis, hyperglycemia, interstitial lung disease, and morbilliform rashes. Rheumatol Int 2005; 25:156-7. [PMID: 14770267 DOI: 10.1007/s00296-004-0448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Accepted: 01/12/2004] [Indexed: 10/26/2022]
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Vitale C, Chiossone L, Cantoni C, Morreale G, Cottalasso F, Moretti S, Pistorio A, Haupt R, Lanino E, Dini G, Moretta L, Mingari MC. The corticosteroid-induced inhibitory effect on NK cell function reflects down-regulation and/or dysfunction of triggering receptors involved in natural cytotoxicity. Eur J Immunol 2004; 34:3028-38. [PMID: 15368269 DOI: 10.1002/eji.200425418] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Corticosteroids are known to inhibit NK cell functions. However no information is available on whether such inhibition may affect the expression and/or the function of receptors involved in NK cell activation. In an attempt to analyze this point, we studied peripheral blood NK cells isolated from pediatric patients undergoing allogeneic BM transplantation. NK cells were analyzed before, during and after methylprednisolone administration to treat acute graft-versus-host disease. In NK cells freshly isolated from peripheral blood during methylprednisolone treatment, the surface expression of activating receptors, particularly NKp46 and NKp30, was consistently reduced. Such impaired expression could also be detected after 5 days of culture in IL-2. Such cultured NK cells also failed to express the IL-2-inducible NKp44 receptor. Accordingly, cytotoxicity against different tumor target cell lines was sharply reduced. The effect on NK cells isolated from healthy individuals and cultured in the presence of methylprednisolone was also analyzed. A similar inhibitory effect occurred in the expression of activating NK receptors. In addition, a sharp impairment of NK cytotoxicity against different tumor target cell lines or immature DC was detected.
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Affiliation(s)
- Chiara Vitale
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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9
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Abstract
A 42-year-old registered nurse presented with a recurrent history of multifactorial hand dermatitis, which had ceased to respond to the topical corticosteroid that she was using. Patch testing revealed strong reactions to both Advantan Fatty Ointment (Commonwealth Serum Laboratories, Melbourne, Australia), and its active ingredient, methylprednisolone aceponate. Methylprednisolone aceponate is one of the more sensitizing topical corticosteroids and is becoming increasingly recognized as a significant allergen.
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Affiliation(s)
- Jennifer Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Victoria, Victoria, Australia
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Chen SG, Wan HL, Chou TD, Chen TM, Wang HJ. Life-threatening hemorrhage during microvascular free tissue transfer in a non-hemophiliac patient with acquired inhibitor to factor VIII. J Trauma 2004; 56:1127-30. [PMID: 15179257 DOI: 10.1097/01.ta.0000091108.21553.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Shyi-Gen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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11
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Affiliation(s)
- Chan Seok Oh
- Department of Dermatology, College of Medicine, The Catholic University of Korea, 62 Youido-dong, Youngdeungpo-gu, Seoul, South Korea
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12
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Martínez-Cáceres EM, Barrau MA, Brieva L, Espejo C, Barberà N, Montalban X. Treatment with methylprednisolone in relapses of multiple sclerosis patients: immunological evidence of immediate and short-term but not long-lasting effects. Clin Exp Immunol 2002; 127:165-71. [PMID: 11882048 PMCID: PMC1906276 DOI: 10.1046/j.1365-2249.2002.01725.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Relapses of multiple sclerosis (MS) are treated commonly with high-dose intravenous methylprednisolone (MP) given over a period of 3-5 days. The mechanisms responsible for the beneficial effects of MP in attacks are not clearly established. It is also controversial whether this treatment may have a long-term effect. Here, peripheral blood samples from relapsing--remitting MS patients in acute relapse were analysed by flow cytometry just before steroid treatment and at different time points after initiation of the therapy. We observed an immediate (day 3) decrease in the percentage of CD4+ lymphocytes, with a relative increase in the memory (CD4+CD45R0+) subpopulation. A longer standing effect of MP on IFN-gamma production, CD54, CCR5, CXCR3 and CD95 (Fas) expression was also observed on CD4+ cells after 1 month of treatment initiation. Six months after the therapy, during clinical remission, no changes due to ivMP therapy were detected. These results support that MP treatment of relapses induces immediate post-treatment and short-term effects on the immune system that could partly account for the clinical and radiological improvement observed in MS patients. However, no conclusion can be drawn as to a possible long-term or even intermediate influence of ivMP treatment on the course of the disease.
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Affiliation(s)
- E M Martínez-Cáceres
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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13
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Beynel P, Guérin JC. [Anaphylactic reactions to systemic corticosteroids. Review of the literature concerning 3 cases]. Rev Mal Respir 1999; 16:529-37. [PMID: 10549063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Despite their antiinflammatory and antiallergic properties, corticosteroids can nevertheless cause adverse allergic reactions. This is currently accepted for local corticosteroids and there have also been about a hundred reports of variable pertinence concerning hypersensitivity reactions to systemic corticosteroids. Based on three cases of immediate hypersensitivity reactions after taking methylprednisolone, we propose a critical review of the literature, focusing particularly on methylprednisolone-induced reactions. The means of investigation currently available in drug-induced hypersensitivity reactions are also discussed.
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Affiliation(s)
- P Beynel
- Hôpital de la Croix-Rousse, Lyon
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Abstract
Two mixed-breed littermate dogs were fed mouse brains containing tissue cysts of the NC-beef isolate of Neospora caninum. Both dogs excreted N. caninum oocysts in their feces. Dog 1 which was given methylprednisolone acetate (MPA) prior to ingesting tissue cysts, excreted oocysts on days 5 to 10 inclusive and on day 17 after ingesting tissue cysts. Dog 1 had a serum antibody titer of 1:200 in the indirect fluorescent antibody test (IFAT) 35 days after it was fed tissue cysts. Dog 2, which was not treated with MPA, excreted oocysts on Day 6 and Day 9 after ingesting tissue cysts. Antibodies to N. caninum were not found in a 1:25 dilution of serum on any examination period for Dog 2 during the study. Neospora caninum was not found in the tissues of either dog by histological or immunohistochemical means following necropsy 42 days after being fed tissue cysts. The identity of the oocysts excreted in the feces of the dogs was confirmed by mouse inoculation studies.
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Affiliation(s)
- D S Lindsay
- Center for Molecular Medicine and Infectious Diseases, Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg 24061-0342, USA.
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Sainte-Laudy J, Vallon C, Guérin JC. [Importance of the leukotriene C4 liberation test for the diagnosis of drug allergy (preliminary results)]. Allerg Immunol (Paris) 1996; 28:44-7. [PMID: 8703308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pharmacological or immunological activation of human basophil induces the expression of membrane markers such as CD63 and the release of histamine and leukotriene C4 (LTC4). LTC4 release test has the advantages of a cellular test which is obviously closer to the physio-pathological reaction than the direct determination of circulating antibodies. Moreover, the determination of a newly formed mediator eliminates the spontaneous release of mediator by simple cellular damage. We present here, after having controlled the reliability of the method for aero-allergens, preliminary results of LTC4 release obtained for haptens (ampicillin, methylprednisolone and acetylsalicylic acid) which are in favour of the use of this method in the complex field of drug allergy diagnosis.
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Affiliation(s)
- J Sainte-Laudy
- Unité d'Immuno-allergologie, laboratoire Cerba, Val d'Oise
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Gallo P, Chiusole M, Sanzari M, Sivieri S, Piccinno MG, Argentiero V, Rizzotti P, Tavolato B. Effect of high-dose steroid therapy on T-cell subpopulations. A longitudinal study in MS patients. Acta Neurol Scand 1994; 89:95-101. [PMID: 8191883 DOI: 10.1111/j.1600-0404.1994.tb01642.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Lymphocyte subpopulations, T cell activation antigens, and serum levels of interleukin 2 (IL-2) and soluble IL-2 receptor (sIL2R), were studied in relapsing-remitting MS (RR-MS) patients before and after high-dose steroid therapy. Prior to therapy, a minority of patients showed increased HLA-DR antigen expression, and an increased number of CD16+ and CD19+ cells. Steroid treatment induced a significant increase in HLA-DR and CD19 expression, a significant reduction in CD16+, CD57+, and CD8+ CD57+ cells, and a slight, non-significant, decrease in IL-2 and sIL-2R levels and CD25 expression on CD4+ T lymphocytes.
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Affiliation(s)
- P Gallo
- Institute of Neurology, Second Neurologic Clinic, University of Padua, School of Medicine, Italy
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Frequin ST, Lamers KJ, Borm GF, Barkhof F, Jongen PJ, Hommes OR. T-cell subsets in the cerebrospinal fluid and peripheral blood of multiple sclerosis patients treated with high-dose intravenous methylprednisolone. Acta Neurol Scand 1993; 88:80-6. [PMID: 8213063 DOI: 10.1111/j.1600-0404.1993.tb04195.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine the effects of high-dose intravenous methylprednisolone (MP) on lymphocytes and lymphocyte subpopulations in the cerebrospinal fluid (CSF) and peripheral blood (PB) in multiple sclerosis (MS) patients, we studied 67 patients with definite MS treated with MP. They were classified according to the disease course: 32 chronic progressive (CP) patients, 25 relapsing-remitting (RR) patients, and 10 patients with a chronic progressive disease course accompanied by relapses and remissions (CP + RR). MS patients were treated with 1000 mgr intravenous MP daily for 10 consecutive days. Before and after MP treatment we simultaneously studied CSF and PB CD3+, CD4+, CD8+, CD20+, and Ia1+ cell subsets. Kurtzke's Expanded Disability Status Scale (EDSS) was used for clinical evaluation. Progression rate was defined as the ratio of EDSS to disease duration. Thirteen patients with lumbar disk herniation were investigated as controls. Before MP, we found in MS patients, especially in the CP group, significantly lower CD4+ T-cell percentages in the PB with respect to controls (p < 0.05). The percentage of CD4+ T-cells in the CSF of MS patients was significantly higher compared with PB (p = 0.0001), and tended to be higher than in controls (p = 0.072). The CSF mononuclear cell counts were significantly correlated with higher percentages of CSF CD3+ (r = 0.40) and CD4+ (r = 0.47) T-cells and lower CSF CD8+ (r = -0.33) T-cell percentages. B-cell percentages in the CSF were significantly elevated compared with controls for all MS groups. No relation could be obtained between T- or B-cell subsets and EDSS or progression rate.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S T Frequin
- Department of Neurology, University Hospital, Amsterdam, The Netherlands
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John GT, Thomas PP, Kirubakaran MG, Thomas M, Jacob CK, Shastry JC. Methylprednisolone sodium succinate-induced anaphylaxis in a nonatopic renal transplant recipient. Transplantation 1989; 48:543. [PMID: 2675420 DOI: 10.1097/00007890-198909000-00047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Wasik M, Rychlik G, Rudnicka L, Górski A. [Cellular cytotoxicity in the studies of immunosuppressive activity of drugs]. Pol Arch Med Wewn 1988; 80:105-12. [PMID: 3271311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Reichenspurner H, Odell JA, Cooper DK, Novitzky D, Human PA, Von Oppell U, Becerra E, Boehm DH, Rose A, Fasol R. Twenty years of heart transplantation at Groote Schuur Hospital. J Heart Transplant 1987; 6:317-23. [PMID: 3320301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Between December 1967 and July 1987, 110 heart transplantations (61 heterotopic and 49 orthotopic) and 12 heart-lung transplantations were done at Groote Schuur Hospital in Cape Town, South Africa. Twelve procedures were retransplantations, including two third interventions. The patients were divided into three groups: Group A (n = 55) from 1967 to 1982 received so-called conventional treatment of azathioprine, methylprednisolone, and antithymocyte globulin. Group B (n = 15) from 1983 to 1984 had cyclosporine in high dosages together with methylprednisolone. Group C (n = 30) received quadruple drug therapy of low-dosage cyclosporine, together with azathioprine, methylprednisolone in lower dosages, and antithymocyte globulin (for the first 4 to 6 days and rescue antithymocyte globulin for severe rejection). From Group A, nine of 55 patients are alive up to 17 years after transplantation. The main causes of death were acute rejections and infections (in 60% altogether). From group B, six of 15 patients are alive. Acute rejections and infections were the causes of death in 12% of the patients, but multiple organ failure was a major cause in 24% most probably because of the high dosages of cyclosporine. From group C, 23 of 30 patients have survived. In this group the results after heterotopic heart transplantation do not differ significantly from orthotopic transplantation, which justifies this procedure in particular situations. If all heterotopic and orthotopic transplantations are compared, orthotopic procedures have a substantially better outcome. With the modified immunosuppressive regimen (group C) combined with precise donor and recipient selection and more sophisticated rejection monitoring, the actuarial survival rate within the last 12 months is 94%.
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Affiliation(s)
- H Reichenspurner
- Department of Cardiothoracic Surgery, University of Cape Town Medical School, South Africa
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