Does Theophylline Have a Role as an Adjunct Agent for Immunosupression in Heart Transplantation Patients?

Despite new medical therapies in immunosuppressive regimen for heart transplantation patients, rejection still has an important role for morbidity and mortality especially in the first three months of transplantation. Theophylline is a drug which can be used to treat post-transplant bradycardia. This drug is also known to have some immunemodulatory effects. In the present study we investigated the clinical and laboratory indices of rejection in 27 patients treated with theophylline for post-transplant bradycardia. We examined 29 patients treated with the same immunosuppressive regimen as the control group. The study was done retrospectively. The clinical risk factors for rejection were similar for both groups. We searched for endomyocardial biopsy scores, number of cellular and humoral rejection episodes and rejection episodes with hemodynamic compromise. We observed that number of cellular and humoral rejection episodes and number of episodes with hemodynamic compromise did not change with theophylline therapy. However, average biopsy scores were influenced favorably with theophylline therapy (control group 0.98 ± 0.51, theophylline group 0.73 ± 0.42) (p=0.04), and time to first rejection was prolonged in patients using theophylline (control group 24 ± 21 days, theophylline group 51 ± 26 days) (p=0.05). We concluded that adding theophylline to the standard immunosuppressive regimen might favorably affect the rejection process. Prospective, randomized, larger studies to test the potential role of theophylline as an adjunct therapy to the standard immunosuppressive regimen is probably indicated.