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D Casarotto

Publications and source records attributed to D Casarotto.

At least 37 records · Page 2Linked to original sources
PubMed1999

Endothelin-1 and its mRNA in the wall layers of human arteries ex vivo.

BACKGROUND: The participation of endothelin-1 (ET-1) in the control of vascular tone in humans has been questioned, on the basis of the finding of subthreshold immunoreactive (ir) ET-1 plasma levels. However, because most ET-1 is secreted abluminally, it might attain a higher concentration in the tunica media than in plasma. Furthermore, evidence indicates that vascular smooth muscle cells (VSMCs) can synthesize ET-1 on stimulation in vitro. We therefore looked for irET-1 in the different layers of the wall of human arteries, including renal, gastric, and internal thoracic artery wall, obtained ex vivo from consenting patients with coronary artery disease and/or high blood pressure undergoing surgery, as well as from young organ donors. METHODS AND RESULTS: We performed immunohistochemistry with specific anti-ET-1 and anti-vWF antibodies followed by detection with an avidin-biotin complex ultrasensitive kit. The presence of preproET-1 and human endothelin-converting enzyme-1 (hECE-1) mRNA was also investigated by reverse transcription-polymerase chain reaction in homogenates of vessel wall, including preparations deprived of both endothelium and adventitia, and in isolated VSMCs. We detected irET-1 in the endothelium of all arteries and in the tunica media of internal thoracic artery from most patients with coronary artery disease. PreproET-1 and hECE-1 mRNA was also detected in VSMCs isolated from these vessels. irET-1 and irvWF staining in endothelium and tunica media was measured by use of microscope-coupled computer-assisted technology. Significant correlations between the amount of irET-1 in the tunica media and mean blood pressure (P<0.05), total serum cholesterol (P<0.05), and number of atherosclerotic sites (P<0.001) were found. Thus, in organ donors, irET-1 was detectable almost exclusively in endothelial cells, whereas in patients with coronary artery disease and/or arterial hypertension, sizable amounts of irET-1 were detectable in the tunica media of different types of arteries. In addition, VSMCs isolated from these vessels coexpressed the preproET-1 and hECE-1 genes. CONCLUSIONS: Collectively, these findings are consistent with the contention that endothelial damage occurs in most patients with atherosclerosis and/or hypertension and that ET-1 is synthesized in VSMCs of these patients.

Adult↗
PubMed1999

Reoperations for acute prosthetic thrombosis and pannus: an assessment of rates, relationship and risk.

OBJECTIVE: Mechanical valvular prostheses have the advantage of longevity but carry a risk of thrombosis which is dependant on valve design, materials and host-related interface. While pannus is common to both biologic and mechanical valves, acute prosthetic thrombosis is mostly a complication of mechanical valves; therefore we investigated to find rates and risk of these obstructive complications. METHODS: Between 1/1/70 and 31/12/97, 2680 patients received at least one mechanical prosthesis in the aortic or mitral or tricuspid position and a total of 3014 operations were performed. Follow-up included 18523 years and was 98% complete. Incidence rates, Kaplan-Meier estimates, modeling of the hazard and multivariate analysis in the hazard domain were used in the analysis. RESULTS: Overall survival was 76%, 64%, 51%, 38.5% and 29% at 5, 10, 15, 20 and 25 years, respectively. It was significantly better in aortic than in mitral than in double prosthesis. 290 patients received a single reoperation, 37 a second, six a third and one a fourth reoperation. Two-hundred and fifty-one of these reoperations were exclusively due to malfunction of mechanical prosthesis, nine to malfunction of both mechanic and biologic prostheses. Most frequent reoperative indications was dehiscence (133), pannus (48) and thrombosis (29). The linearized rate of reoperations for pannus was 0.24%/patient per year, for valvular thrombosis 0.15%/patient per year. The shape of the thrombotic hazard was constant (at random) and the relative risk 12 times higher for tricuspid prosthesis, seven times higher for mitral prosthesis. Multivariate analysis controlling for prosthetic position, age, sex and prosthetic size, showed a 67% risk reduction with larger prosthesis (>27 mm), a 69% risk reduction with the Sorin tilting disk prosthesis and an 83% risk reduction with the bileaflet prosthesis. Pannus hazard shows a delayed exponential rise and was two times higher in tricuspid and three times higher in mitral position. Multivariate analysis showed a 50% risk reduction with larger prosthesis, an 11 times higher hazard of old (caged-disk, caged ball) prosthesis and a three times higher hazard of Lillehei-Kaster prosthesis. Reoperation for thrombosis has a 62% perioperative (30 days) survival compared to 92% survival of pannus reoperation. CONCLUSIONS: Mechanical valves have a low incidence of reoperation, mostly for prosthetic dehiscence. Pannus development is the next frequent complication increasing with time since implant, therefore in this series it was related to old valvular models and tilting disk prosthesis, with longer follow-up. Acute thrombosis occurs significantly earlier than pannus formation. Despite shorter follow-up we are therefore confident that bileaflet prostheses are less prone to this complication and pannus is a rare early etiologic factor. Thrombosis has very high operative risk as compared to pannus, justifying the present trend to thrombolysate selected cases.

Acute Disease↗
PubMed1999

Myocardial region (right or left ventricle) and aetiology of heart failure can influence the inotropic effect of ouabain in failing human myocardium.

AIMS: To investigate whether the inotropic effect of ouabain in failing human myocardium varies according to the heart chamber tested (right or left ventricle) or the aetiology of the heart disease, i.e. ischaemic or idiopathic. METHODS: The inotropic effect of ouabain was measured, as the percentage change in baseline tension, in myocardial strips isolated from right (RV; n=21) and left ventricles (LV; n=21) of hearts explanted from patients with idiopathic (IDC; n=11) and ischaemic cardiomyopathy (CAD; n=10). Concentration-effect curves obtained with ouabain (0.05-1.6 micromol l-1 ) were analysed using the Emax sigmoidal model, and the following parameters were calculated: Emax, EC50, n and EC10 (threshold concentration). The influence of ventricular chamber and heart failure aetiology on these parameters was evaluated by means of a two-way anova. RESULTS: Age and baseline haemodynamic parameters did not differ between IDC and CAD patients. Baseline strip contractility was highly variable (range: 0.48-10.0 mN), but neither ventricular chamber nor aetiology could explain such variability. A two-way anova showed that EC10 was greater in CAD than in IDC preparations (0.097+/-0.013 micromol l-1 vs 0.059+/-0. 009 micromol l-1; 95% C.I. for difference 0.043, 0.071) and Emax was lower in RV than in LV (121+/-21% vs 250+/-38%; 95% C.I. -221, -36), while EC50 and n were not significantly different between groups. CONCLUSIONS: The inotropic effect of ouabain in human myocardium may vary according to aetiology of heart failure and the ventricle being tested. Although our results do not support the hypothesis of increased sensitivity to cardiac glycosides in CAD patients, they may explain the diminished effect observed in patients with RV failure.

Aging↗
PubMed1999

Transaortic gradient is pressure-dependent in a pulsatile model of the circulation.

BACKGROUND AND AIM OF THE STUDY: Although the transvalvular gradient is described as flow-dependent, pressure-dependence of the gradient, irrespective of flow, has not been demonstrated. METHODS: The Sheffield pulse duplicator equipped with a X-Cell 21 porcine valve mounted in the aortic position was used. Transaortic gradient was measured at a constant rate of 80 beats/min, while flow was kept at 2, 5 or 8 l/min, and systemic pressure was increased up to 200 mmHg by adjusting peripheral resistance manually. Valve area was computed with the Gorlin formula. A total of 87 measurements was carried out. RESULTS: For each flow, transvalvular gradient increased linearly with pressure, and computed area decreased. The slope of the pressure-gradient relationship was independent of flow. CONCLUSION: Transaortic gradient depends not only on flow, but also shows pressure-dependency that should be taken into account when evaluating aortic stenosis, especially in hypertensive and hypotensive states.

Aortic Valve↗
PubMed1998

Multivariate analysis of survival after malfunctioning biological and mechanical prosthesis replacement.

BACKGROUND: Results of valvular reoperations depend on extrinsic and patients' intrinsic risk factors. New prosthetic substitutes continue to appear and the clinical effect is difficult to evaluate. Randomized studies are limited by patient selection and follow-up time. We followed the patient-centric outcome research applied to a large database of valvular operations. METHODS: Between January 1, 1970 and January 1, 1995 755 patients underwent one reoperation, 96 a second reoperation, and 12 a third reoperation. On January 1, 1996 a common closing date follow-up was obtained in 98.7% of reoperated patients. Multivariable analysis in the hazard domain was applied to obtain an upgradable model of survival that could be used for predictions and treatment comparison. RESULTS: Postoperative death hazard showed an early phase merging within 6 months with a constant low hazard phase. The survival proportion was 0.65 (70% CL, 0.63 to 0.67) at 5 years, 0.51 (70% CL, 0.49 to 0.53) at 10 years, 0.47 (range, 0.44 to 0.49) at 15 years, 0.42 (70% CL, 0.39 to 0.46) at 20 and 25 years. Significant incremental risk factors for early mortality were reoperative era 1970 to 1980 (hazard ratio = 2.8), reoperation number (hazard ratio = 1.9), heart penetration on surgery (hazard ratio = 7.6), emergent operation (hazard ratio = 5.8), urgent operation (hazard ratio = 2.1), prosthetic thrombosis (hazard ratio = 2.4), acute prosthetic endocarditis (hazard ratio = 3.0), acute endocarditis of the natural valve at antecedent operation (hazard ratio = 3.2), original floppy valve pathology (hazard ratio = 3.2), and mitroaortic replacement (hazard ratio = 5.7). Isolated mitral reoperation had a lower risk (hazard ratio = 0.5). Significant incremental risk factors for constant phase were: operative era (1970 to 1980) (hazard ratio = 2.0), congestive heart failure (hazard ratio = 2.6), reoperation on tricuspid valve after previous mitral insertion (hazard ratio = 4.9), reoperation for recurring dehiscence (hazard ratio = 4.6), double-valve procedure (hazard ratio = 1.6), coronary artery bypass graft (hazard ratio = 2.7), aortic root disease at original operation (hazard ratio = 2.1), older operative age (hazard ratio = 1.1). Use of bileaflet prosthesis was found to decrease significantly (p = 0.0002) the death risk (hazard ratio = 0.2). CONCLUSIONS: There is no late uprising hazard, and surviving patients remain exposed to a low risk of death (4% of patients per year). Considering simultaneously the confounding from operative age and operative era and the many concomitant risk factors, survival appears favorably influenced by use of bileaflet valves on reoperation.

Adolescent↗
PubMed1998

Prosthetic replacement of the tricuspid valve: biological or mechanical?

BACKGROUND: Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations performed between June 6, 1966 and April 18, 1996. Many series report similar figures, but institutional experience is limited and the consensus on treatment modalities is lacking. METHODS: One hundred tricuspid operations were performed on 83 patients (46 female). A primary operation was performed in 64 cases, 13 patients had one previous operation, 4 patients had two previous operations, and 2 patients had three previous operations. Seventeen patients required a tricuspid prosthetic valve rereplacement. There were 2 emergent and 17 urgent operations. The New York Heart Association class was IV in 13 patients (mean pulmonary artery pressure, 41 mm Hg), III in 66 patients (mean pressure, 38 mm Hg), and II in 21 patients. The most frequent operation was simultaneous replacement of the mitral and tricuspid valve (41 patients). Seventy biological and 30 mechanical prostheses were used. Total follow-up time was 613 years, mean 7.4 years (median 4.2 years), with a maximum of 27.8 years, and was 92% complete. RESULTS: Operative mortality was 24%. Survival was 0.54 (0.48 to 0.59, n = 39) at 5 years, 0.38 (0.32 to 0.44, n = 27) at 10 years, 0.31 (0.25 to 0.36, n = 19) at 15 years, 0.29 (0.23 to 0.34, n = 11) at 20 years, and 0.17 (0.098 to 0.26, n = 3) at 25 years. Early mortality was increased from higher New York Heart Association class (hazard ratio = 2.2), congenital disease (hazard ratio = 6.9), and valvuloplasty failure (hazard ratio = 4.3). The constant risk phase (4%/patient-year) after 2 years was enhanced by older operative age (hazard ratio = 1.4). Prosthetic type had no independent effect. Biological prostheses were at risk for 300 years and had a reoperation incidence of 4.7%/ patient-year (14 events); mechanical prosthesis were at risk for 137 years with a rate of 2.2%/patient-year (3 events) (p = 0.21). Three valve thromboses were observed in old-design mechanical prosthesis. Bioprosthetic degeneration showed a steeper rate after 7 years. CONCLUSIONS: This study does not show a clear superiority of biological versus mechanical prostheses. In the long run survival with mechanical prostheses could be superior, given the high rate of bioprosthetic degeneration after 7 years.

Adolescent↗
PubMed1997

Cardiac lithomyxoma.

Among 102 consecutive cardiac myxomas, 10 (10%) showed heavy calcification both on gross inspection and on x-ray examination. Mineralization was partial in 6 patients (mean age 56.8 years) and massive stone-like in 4 (mean age 70 years); relevant histologic findings in patients with partial calcification were Gamma-Gandy bodies in 5, cartilaginous and bone metaplasia in 2, and aspecific calcium deposits in 1. All were incidental findings either at autopsy or during clinical investigation.

Calcinosis↗
PubMed1997

Postextrasystolic potentiation and dobutamine echocardiography in predicting recovery of myocardial function after coronary bypass revascularization.

BACKGROUND: Identification of viable but hibernating myocardium remains a relevant issue in the current era of myocardial revascularization. Echocardiography can be helpful in detecting reversible contractile dysfunction and optimizing the selection of patients for coronary bypass surgery. METHODS AND RESULTS: Eighty-four consecutive candidates for bypass surgery with chronic multivessel coronary artery disease were screened, and 60 were included in this prospective study. Preoperative evaluation of a reversible contractile dysfunction in asynergic myocardial regions was performed by dobutamine infusion at 5 (low dose) and 10 (intermediate dose) microg x kg(-1) x min(-1) with each stage lasting at least 5 minutes; postextrasystolic potentiation (PESP), with a coupling interval ranging from 500 to 300 ms with a progressive 10-ms decrease; or a combination of both dobutamine infusion and PESP. Sensitivity (92% versus 86%) and predictive accuracy (89% versus 84%) were higher with PESP than dobutamine (P=.009 and P=.001, respectively), but the combination did not improve sensitivity or accuracy. Dobutamine induced ischemic dysfunction in 15% of patients at the intermediate dose; however, the low dose resulted in loss of sensitivity. CONCLUSIONS: PESP echocardiography is a useful and cost-effective method to identify viable myocardium in patients with multivessel coronary disease undergoing revascularization and is more sensitive and accurate than dobutamine infusion.

Adult↗
PubMed1997

Aortic dissection type A versus type B: a different post-surgical death hazard?

OBJECTIVE: Patients with type B aortic dissection differ from patients with type A dissection in age, hypertension prevalence, indications and timing of surgical treatment, yet reported long-term results have been rather similar (see Doroghazi et al. J Am Coll Cardiol 1984;3:1026-1034). METHODS: With the aim of comparing the post-surgical history, we have reviewed our results in 288 dissections, 213 type A and 75 type B, operated consecutively between 1 January 1970 and 31 November 1994. Follow-up was 100% complete. Empirical survival of both groups was interpolated with a fully parametric method and the shape and scale of the hazard function was investigated. RESULTS: Survival was not significantly different between type A and type B. Parametric survival was, respectively, 0.52% (70% C.L.: 0.48-0.55) vs. 0.56% (0.51-0.62) at 5 years, 0.44% (0.40-0.47) vs. 0.28% (0.23-0.25) at 10 years, 0.37% (0.33-0.41) vs. 0.25% (0.19-0.32) at 15 years, and 0.31% (0.26-0.35) vs. 0.24% (0.18-0.31) at 20 years. Following the high perioperative risk phase in type A dissection, the intermediate and late risk remains constant at a rate of 0.0033 events/month (3.9% patient-years (pt.-years)). By contrast, the postoperative course of type B dissection shows an intermediate risk phase between 4 and 10 years with an average linearized risk of 9.3% pt.-years and a peak of 20%. This determined lower survival rates (24 vs. 31% at 20 years, P = NS). CONCLUSIONS: We conclude that patients with type B dissection have a steeper postoperative death hazard as compared to type A dissection patients. Age confounding or late entry do not explain the difference. This could be possibly related to a greater propensity for expansion, higher risk of malperfusion complications or to limitations of our current surgical treatment.

Adult↗
PubMed1997

Surgical pathology of primary cardiac and pericardial tumors.

OBJECTIVE: Retrospective study of surgical pathology experience on cardiac and pericardial tumors at the University of Padua in the era of immunohistochemistry and endomyocardial biopsy. METHODS: In the period 1970-1995, we studied 125 bioptic primary neoplasms: specimens were obtained from surgical resection in 116 cases, heart transplantation in 3, pericardiectomy in 3, endomyocardial biopsy in 2 and thoracoscopic biopsy in 1. Tumor histotype was established by light microscopy and more recently by immuno-histochemistry, using a large panel of antibodies, through avidin-biotin peroxidase method, against factor VIII-related antigen, ulex-europaeus, desmin, myoglobin, muscle-specific actin, smooth muscle-specific actin, vimentin, cytokeratins, leukocytic common antigen, neurofilaments and S100-protein. RESULTS: One hundred and thirteen were benign neoplasms: myxoma was the most frequent (87 cases) followed by pericardial cyst (8), endocardial papilloma (5), fibroma (3), rhabdomyoma (3), hematic cyst (2), teratoma (2), hemangioma (1), celothelioma (1) and lipoma (1). Malignancy was diagnosed in 12 cases, and consisted of pericardial mesothelioma (3), myxosarcoma (3), angiosarcoma (2), fibrosarcoma (2) and leiomyosarcoma (2); 4 of them were intracavitary atrial masses and were supposed to be atrial myxoma on the clinical ground. Differential diagnosis included endocardial thrombosis (10), metastasis of concealed extracardiac tumors (5), echinococcosis (3), and Loeffler's fibroplastic endocarditis (3). In 4 cases, cardiac mass histotype was defined without thoracotomy, through endomyocardial (3) and thoracoscopic (1) biopsy. CONCLUSIONS: A large spectrum of cardiac tumors is observed in the surgical pathology practice. Although the diagnosis of cardiac masses is easily attainable by routine imaging techniques, differential diagnosis between primary and secondary tumors, malignant and benign forms, and non neoplastic masses, is achievable only by a thorough microscopic study of surgical resections. The role of the cardiac pathologist is becoming crucial as in other fields of oncology.

Adolescent↗
PubMed1997

Aorto-right atrial fistula: a rare complication of aortic dissection type A. A report of two cases.

BACKGROUND: Aortic dissection with rupture into the right atrium is an extremely rare condition and rapidly lethal. The authors report their experience in the treatment of two complicated aortic dissections observed at 85 and 93 months after previous cardiac operations. These were redo mitral valve replacement and saphenous vein coronary artery bypass grafts. METHODS: Both cases underwent hospital admission on an emergency basis because of severe chest pain and cardiac failure. One case had a history of hypertension. The aortography revealed aortic dissection and a fistulous communication into the right atrium. At surgery dissection repair and closure of the fistula was performed. Furthermore in one case vein grafts were reimplanted into the vascular graft. RESULTS: Both patients survived the operation without complications, were rapidly extubated and were asymptomatic and fully active at late follow-up. CONCLUSIONS: In the light of these results we conclude by affirming that aortic dissection with rupture into the right atrium is an extremely rare condition, rapidly lethal. Patient survival is strictly dependent on the time interval between fistulization of the dissection and the operation.

Aged↗
PubMed1996

Evolution of focal moderate (International Society for Heart and Lung Transplantation grade 2) rejection of the cardiac allograft.

BACKGROUND: In the absence of clinical evidence of cardiac allograft rejection, it is still poorly defined whether the International Society for Heart and Lung Transplantation biopsy grade 2 (e.g., focal moderate rejection) should be treated. Aim of the present study was to retrospectively investigate the evolution of focal moderate rejection, diagnosed during the first postoperative year in patients who had undergone orthotopic heart transplantation. METHODS: A retrospective analysis was conducted on 256 International Society for Heart and Lung Transplantation grade 2 biopsies from 110 orthotopic heart transplantations; 125 episodes occurred within the first 3 months (group 1), 131 later (group 2). For each grade 2 diagnosis, two biopsies, one immediately before and one after, were analyzed and classified as follows: lower (grade 0 or 1), equal (grade 2), or higher (grade 3 or 4). RESULTS: Evolution of grade 2 rejection was to a lower grade in 66% of cases, an equal grade in 16.8%, and a higher grade in 17.2%, with differences between group 1 and 2 (higher: 25% versus 10%, respectively, p = 0.005). Episodes which progressed into higher grades occurred earlier compared with those which persisted or resolved (9.2 +/- 8.6 weeks versus 20.0 +/- 15.6, p < 0.001). Five-year actuarial survival and incidence of graft coronary disease were similar in patients whose conditions progressed and those whose conditions did not. However, left ventricular ejection fraction at 1 and 2 years was lower in patients whose conditions progressed compared with those whose conditions persisted or resolved (56% +/- 4% versus 66% +/- 2%, p = 0.004; 56% +/- 10% versus 64% +/- 8%, p = 0.02, respectively). CONCLUSIONS: Progression of grade 2 rejection occurred in a minority of cases and did not affect 5-year survival or incidence of coronary disease, but its relationship with long-term cardiac allograft dysfunction warrants further investigation.

Actuarial Analysis↗
PubMed1996

Aortic dissection in puerperium: a case report.

An acute type A aortic dissection, complicated by massive aortic regurgitation, was diagnosed in the case of a 32-year-old woman, thirty-three days post partum. Emergency operation (Cabrol II) was performed with an uneventful postoperative course. We draw attention to this high risk event, which is particularly apt to involve women within a short time after an otherwise uneventful pregnancy.

Adult↗
PubMed1996

Low-profile porcine bioprosthesis (Liotta): pathologic findings and mode of failure in the long-term.

BACKGROUND AND AIMS OF THE STUDY: The Liotta low profile porcine bioprosthesis (LBP) was designed in order to minimize complications due to excessive protrusion of the stent prongs in the left ventricle. MATERIALS AND METHODS: From April 1984 to November 1993, 25 LBP surgical explants were available for pathology study, which included gross and X-ray evaluations. Reoperation was performed after a mean period of 95 +/- 25 months (range 46 to 143 months), in five males and 20 females (mean age at implantation 51.1 +/- 11.4 years). RESULTS: The cause of failure was stenosis due to cusp stiffness caused by dystrophic calcification in one and incompetence in 24 LBPs. In only one case was incompetence ascribable to endocarditis; in the remaining 23 the mechanism of regurgitation was due to commissural tearing (21 LBPs), commissural dehiscence (one LBP) and both tears and dehiscence (one LBP). Overall, 28 commissural tears were observed: 20 involved the right coronary cusp, eight the left coronary cusp, and none the non-coronary cusp. The anterior commissure was most frequently involved by tears (n = 17) followed by the right posterior (n = 9) and the left posterior (n = 2). Tears were calcium-related in all but two cases. Calcific deposits were observed in each explant, involving a total of 62 commissural attachments, 17 cusp bodies and five right muscular shelves. CONCLUSION: In conclusion, valve regurgitation is the usual mode of LBP failure in the mitral position; commissural tearing of the right coronary cusp was the most common cause of valve regurgitation, and occurred even in the presence of pin-point calcification. These pathologic findings seem to confirm that low profile design, which implies bulging of the right coronary cusp, entails the risk of increased stress at the commissures, accelerated calcification and tearing.

Adult↗
PubMed1995

Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection.

Recurrent rejection is an uncommon, severe complication after heart transplantation that is associated with a poor long-term prognosis. Photopheresis (ECP), a new form of extracorporeal photo-chemotherapy used for the treatment of cutaneous T cell lymphoma and several autoimmune diseases, has also been used for prevention and treatment of acute rejection in heart transplant recipients. It seems to induce specific suppression of both cellular and humoral rejection. In this study, we evaluated whether ECP added to standard therapies allowed better control of rejection and reduction of conventional immunosuppressive drugs in patients with repeated rejection episodes. Eight heart transplant recipients (6 men and 2 women, mean age 48 yr), with recurrent rejection were treated with ECP for 6 months. Endomyocardial biopsies (EMB) were performed monthly. As a result of treatment, 7 patients on ECP experienced a reduction of the number and severity of rejection episodes. The fraction of EMB negative for rejection increased from 13 to 41%, whereas the fraction of specimens with multifocal and/or diffuse moderate lymphocytes infiltration (grades 3A and 3B) decreased from 41 to 21%. ECP allowed reductions of daily immunosuppressive therapy: prednisone by 44% (16.9 vs. 9.4 mg), cyclosporine by 21% (366 vs. 291 mg), and azathioprine by 29% (137 vs. 97 mg). No major side effects were observed. We conclude that, although the number of patients is small, the use of ECP was safe and associated with improved control of recurrent rejection. This allowed tapering of immunosuppressive drugs, which was particularly useful in two patients with insulin-dependent diabetes and one with sternal wound osteomyelitis.

Adult↗