Methotrexate therapy in pediatric heart transplantation as treatment of recurrent mild to moderate acute cellular rejection

We have used adjunctive therapy with methotrexate as treatment of recurrent mild-to-moderate acute cellular rejection and in an attempt to reduce rejection frequency and corticosteroid dosage. The purpose of this study was to review our experience with this treatment strategy. Eight patients, 13.1 ± 1.1 years of age (mean ± standard error of the mean) at the time of transplantation, were given methotrexate in addition to their standard triple therapy immunosuppression. Methotrexate was started at 6.2 ± 2 months after transplantation after an average of 3.1 ± 0.4 rejection episodes. Patients were given methotrexate weekly for 8 weeks at 2.5 or 5 mg orally every 12 hours for three doses (0.23 ± 0.02 mg/kg/week). The time to resolution of rejection was 17.9 ± 4 days after initiating methotrexate therapy