Therapeutic immunosuppression in cardiac transplantation.

There is continual re-evaluation of immunosuppressive protocols as clinical experience increases in cardiac allotransplantation. Loyola University Medical Center has performed 44 heart transplants over a span of 18 months. The initial protocol was a distillate of several established regimens (Stanford, Pittsburgh, and Papworth). Since its inception, cyclosporine loading dosage has been reduced between 20 to 50 percent. Azathioprine in graded dosage is automatically added immediately post transplantation, corticosteroids are rapidly decreased, and cumulative antithymocyte globulin dosage is less. Except for the use of methotrexate as a last alternative, rejection episodes are treated conventionally. Very little nephrotoxicity has occurred with any of the protocols.