BACKGROUND: The most frequently administered treatment for asymptomatic ISHLT Grade 3A cardiac allograft rejection is intravenous @entity230 or oral @entity134 pulse with a taper. This study analyzes the efficacy of 3-day 100-mg course of @entity229 without a tapered regimen for the treatment of asymptomatic moderate cardiac allograft rejection. METHODS: All new episodes of asymptomatic ISHLT Grade 3A rejections were treated with oral @entity134 pulse without taper, consisting of 100 mg of @entity229 for 3 consecutive days followed by resuming the pre-rejection @entity134 dose on the fourth day. We retrospectively reviewed the histologic response of all treated episodes among all cardiac transplant recipients transplanted between January 1995 through December 1997 who were treated with triple therapy consisting of @entity205 , @entity500 and @entity230 . @entity1 receiving additional or alternative immunosuppressives were excluded from the study. The treated episodes were analyzed as responders if the follow-up biopsy were Grade 0, 1A, 1B, or 2; treatment was counted as non-responders if the follow-up biopsy showed Grade 3A or higher. RESULTS: Of 230 cardiac transplant recipients, 100 @entity1 received a 3-day 100 mg course of @entity229 without taper for 174 new episodes of asymptomatic ISHLT Grade 3A rejection. The overall response rate was 75% (130/174 rejection episodes). A significant difference in the response rate was observed depending on the number of days post transplant. A comparison of the success rates among rejections which occurred > 90 days post transplant versus < 30 days revealed responses to be 88% versus 70% (p = 0.02); for rejections treated > 60 days post transplant versus < 30 days showed success rates of 84% versus 70% (p = 0.04). The mean age of the recipient revealed a trend to be lower among the non-responder group (49+/-12 years versus 53+/-9 years, p = 0.07). Having left ventricular assist device as a bridge to transplant did not significantly affect the treatment outcome. The response rates were 69% for the @entity1 who required the assist device versus 77% for those not bridged (p = ns). There was no significant difference in the gender or the baseline immunosuppressive doses between the responders and non-responders. The cost of a 3-day outpatient, visiting nurse supervised intravenous @entity134 therapy versus 3 days of oral @entity229 was  861 vs  6.88. CONCLUSION: Oral @entity134 pulse without taper is an effective and economical way to treat asymptomatic moderate grade cardiac allograft rejection. A 3-day course of 100 mg of @entity229 without taper should be considered as first line of therapy for clinically stable form of moderate cardiac allograft rejection occurring > 60 days post transplant.

Oral XXXX pulse without taper for the treatment of asymptomatic moderate cardiac allograft rejection.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity500 :: ('MESH:D001379', 'Chemical') :: ['azathioprine'] @entity229 :: ('MESH:D011241', 'Chemical') :: ['prednisone'] @entity134 :: ('CHEBI:35341', 'Chemical') :: ['steroid'] @entity205 :: ('MESH:D016572', 'Chemical') :: ['cyclosporine'] @entity230 :: ('MESH:D013256', 'Chemical') :: ['steroids']
@entity134 :: (CHEBI:35341,Chemical) :: ['steroid']
