The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 951-955, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Immunosuppression after heart transplantation: prednisone and cyclosporine with and without azathioprine
AS Casale, BA Reitz, PS Greene, S Augustine and WA Baumgartner
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Fifty-four patients (group I) underwent isolated heart transplantation
between July 1983 and January 1987 and were immunosuppressed with oral
prednisone and cyclosporine. Twenty-three patients (group II) were
transplanted between January 1987 and June 1988 and were immunosuppressed
with oral prednisone, azathioprine, and cyclosporine, with lower targeted
cyclosporine blood levels. The groups were similar in sex distribution of
both donors and recipients. Primary cardiomyopathy was the primary
recipient diagnosis in two thirds of patients in both groups. Donor age,
graft ischemic time, and length of recipient hospitalization after
transplant were similar. There was a trend toward transplantation of older
patients in group II, and group II patients were more likely to receive
hearts from local donors. Actuarial survival at 24 months was 75% in group
I and 92% in group II. Patients who had triple-drug immunosuppression had
statistically less early rejection but more early infections that tended to
be minor. Hypertension requiring treatment occurred in 63% of group I
patients and 62% of group II patients within the first 9 months after
transplantation. Elevation of serum creatinine greater than 2.0 mg/dl
occurred in 34% of group I patients and 15% of group II patients. A
triple-drug immunosuppressive protocol is associated with less early
rejection but more early minor infectious episodes. Although the incidence
of hypertension is not reduced, there is a trend toward less nephrotoxicity
and better survival.
