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Cardiac transplant rejection – steroids — RACP Paediatrics MCQ

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HardCardiologyCardiac transplant rejection – steroidsRACP Paediatrics

A 10-year-old is 2 years post cardiac transplant on standard triple immunosuppression. Routine surveillance endomyocardial biopsy shows grade 2R cellular rejection. He is asymptomatic with normal graft function. What is the appropriate first-line treatment for acute cellular rejection?

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Correct answer: D — Prednisolone

Acute cellular rejection grade ≥2R on endomyocardial biopsy requires augmented immunosuppression. First-line treatment is high-dose IV methylprednisolone (pulse therapy) followed by oral prednisolone taper. If haemodynamically significant rejection or steroid-resistant rejection, anti-thymocyte globulin may be needed. Baseline immunosuppression is also optimised.

Reference: RCH Melbourne – 2023 – Transplant CPG; RACP Paediatric Curriculum – Cardiology