Abstract 14860: Prednisone Wean After Heart Transplantation - Is There a Risk for Antibody Formation?
BACKGROUND: Prednisone (pred) withdrawal after heart transplantation (HTx) is usually limited to select patients (pts) demonstrating low or no rejection (rejn) rates, are not highly sensitized, or are not multiparous. These pts are an immune-privileged group. However, up to 20% fail pred wean, many due to rejn. There is concern that pred wean may place pts at a higher risk for developing circulating antibodies (Abs). We therefore evaluated our pts on triple drug immunosuppression to assess for development of Abs after pred wean.
METHODS: We evaluated 72 HTx pts between 2010-12 who had routine circulating Ab (PRA) measurements. Pred wean was initiated at 6 months (mths) post HTx in select pts and tapered off over the following 6 mths. The presence of PRA (≥10%) was documented prior to HTx and every 6 mths thereafter. Pts were required to have ≥3 PRA measurements over the study period. Rejn (ISHLT ≥2R and/or ≥AMR2) was monitored from time of HTx to 1 year after pred wean.
RESULTS: 35 pts were successfully weaned off pred (SPW), 6 pts failed pred wean (FPW), and 31 pts were maintained on pred (MP). SPW had significantly lower PRA (p<0.05) compared to MP at 6 mths (20% vs. 48%), 12 mths (11% vs. 56%), and 18 mths (17% vs. 43%) after HTx (table). FPW had higher PRA at 12 mths compared to SPW (50% vs. 11%; p<0.05). Among 23 non-sensitized pts at HTx in the SPW group, only 1 (4%) developed de novo Ab immediately post pred wean and these Ab were not detectable at 18 mths post-HTx. MP pts were more likely to develop de novo Abs (22% and 18% at 12- and 18-mths post-HTx, respectively). Freedom from any treated rejn (97% vs. 67% vs. 77%; p=0.029) and cellular rejn (100% vs. 67% vs. 90%; p=0.008) at 2 years was significantly higher in SPW compared FPW and MP pts, respectively. There was a trend for greater freedom from AMR in SPW pts compared to FPW and MP (100% vs. 83% vs 97%; p=0.077).
CONCLUSION: Pts successfully weaned off pred after HTx do not appear to increase the risk for development of circulating Abs or allograft rejn.
- © 2013 by American Heart Association, Inc.