Prednisone is widely used by most heart transplant units, despite its frequent side effects. Deflazacort, a new oral synthetic steroid with fewer side effects, has not been studied in heart transplant patients. Our initial experience with 26 heart transplant patients in whom prednisone was replaced by deflazacort at 11 +/- 11 months after transplantation is reported. After the switch to deflazacort, a significant decreased was noted in glycemia, total cholesterol, and LDL-cholesterol (p < 0.001). No difference was noted in severity or frequency of rejection and infection between patients being treated with deflazacort and another 26 patients who continued to be treated with prednisone over a comparable period of time after transplantation.