Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level
Background. Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods. We assigned stable posttransplant...
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| Format: | Article |
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Wiley
2018-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2018/3740395 |
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| author | David A. Baran Cheryl Rosenfeld Mark J. Zucker |
| author_facet | David A. Baran Cheryl Rosenfeld Mark J. Zucker |
| author_sort | David A. Baran |
| collection | DOAJ |
| description | Background. Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods. We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol < 8 micrograms/deciliter were assigned to a “maintenance” group and the others were assigned to the weaning group and steroids were tapered off over 4–6 weeks. Patients were monitored on subsequent office visits for adrenal insufficiency and allograft rejection. Results. Thirty-one patients were enrolled (6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2±4 years for the weaning group and 9.0±4.9 years in the maintenance group (p=0.6). No cases of rejection were noted, nor did any patient resume steroid treatment following discontinuation. Conclusion. Steroids can be safely discontinued in stable heart transplant patients with an AM serum cortisol ≥ 8 micrograms/deciliter with appropriate outpatient follow-up. In this study, no patient suffered late rejection or clinically noted adrenal insufficiency. |
| format | Article |
| id | doaj-art-5520e71a45f9448da9fa6f838d4fe6fe |
| institution | OA Journals |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Journal of Transplantation |
| spelling | doaj-art-5520e71a45f9448da9fa6f838d4fe6fe2025-08-20T02:05:07ZengWileyJournal of Transplantation2090-00072090-00152018-01-01201810.1155/2018/37403953740395Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol LevelDavid A. Baran0Cheryl Rosenfeld1Mark J. Zucker2Advanced Heart Failure and Transplant, Sentara Heart Hospital, Norfolk, VA, USAHeart Failure Treatment and Transplant Program, Newark Beth Israel Medical Center, Newark, NJ, USAHeart Failure Treatment and Transplant Program, Newark Beth Israel Medical Center, Newark, NJ, USABackground. Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods. We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol < 8 micrograms/deciliter were assigned to a “maintenance” group and the others were assigned to the weaning group and steroids were tapered off over 4–6 weeks. Patients were monitored on subsequent office visits for adrenal insufficiency and allograft rejection. Results. Thirty-one patients were enrolled (6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2±4 years for the weaning group and 9.0±4.9 years in the maintenance group (p=0.6). No cases of rejection were noted, nor did any patient resume steroid treatment following discontinuation. Conclusion. Steroids can be safely discontinued in stable heart transplant patients with an AM serum cortisol ≥ 8 micrograms/deciliter with appropriate outpatient follow-up. In this study, no patient suffered late rejection or clinically noted adrenal insufficiency.http://dx.doi.org/10.1155/2018/3740395 |
| spellingShingle | David A. Baran Cheryl Rosenfeld Mark J. Zucker Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level Journal of Transplantation |
| title | Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level |
| title_full | Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level |
| title_fullStr | Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level |
| title_full_unstemmed | Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level |
| title_short | Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level |
| title_sort | corticosteroid weaning in stable heart transplant patients guidance by serum cortisol level |
| url | http://dx.doi.org/10.1155/2018/3740395 |
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