Aggressive steroid weaning after cardiac transplantation is possible without the additional risk of significant rejection.

Background: Chronic steroid use after cardiac transplantation (CTX) is accompanied by co-morbidities that are dependent on length of exposure.

Methods: A retrospective review of all CTX without induction therapy from 1999-2004. After 2001, an aggressive strategy of steroid weaning was introduced.

Results: A total of 165 patients underwent CTX, 82 from 1999-2001 (group 1) and 83 from 2002-2004 (group 2). There were no significant differences in recipient or donor characteristics between group 1 and group 2. The baseline calcineurin was cyclosporine in 41% and 5% (p < 0.0001) and tacrolimus in 59% and 95% (p < 0.0001), respectively. The mean duration of steroid use was 1023 d in group 1 and 383 d in group 2 (p < 0.0001). The overall incidence of any > or =ISHLT grade 3A rejection per year after CTX for group 1 vs. group 2 was as follows: year 1: 40% vs. 49% (p = NS) and year 2: 7.4% vs. 9.2% (p = NS).

Conclusions: Steroid withdrawal by one yr after CTX using a contemporary immunosuppressive regimen is possible in most patients. In comparison with a slower steroid wean, a faster wean is not associated with an excess of significant rejection in the first two yr post CTX.