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Clin Transplant. 2018 Aug;32(8):e13340. doi: 10.1111/ctr.13340. Epub 2018 Jul 26.

Duration of corticosteroid use and long-term outcomes after adult heart transplantation: A contemporary analysis of the International Society for Heart and Lung Transplantation Registry.

Author information

1
Cardiac Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
2
University of Utah School of Medicine, Salt Lake City, Utah.
3
International Society for Heart and Lung Transplantation Registry, Dallas, Texas.
4
United Network for Organ Sharing (UNOS), Richmond, Virginia.
5
Cardiac Transplant Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
6
Cardiac Transplant Program, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Long-term corticosteroid (CS) maintenance remains an effective option for immunosuppression following heart transplantation. We used the International Society for Heart and Lung Transplantation Registry to examine characteristics and long-term survival among heart transplant recipients with different duration of CS therapy.

METHODS:

Primary adult heart recipients transplanted between 2000 and 2008 who survived at least 5 years were categorized into three groups according to CS use: early withdrawal (≤2 years) (EARLY D/C), late withdrawal (between 2 and 5 years) (LATE D/C), or long-term use (>5 years) (LONG-TERM). Recipient and donor characteristics, post-transplant morbidities, and mortality were compared among groups. Kaplan-Meier was used to estimate survival up to 10 years post-transplant.

RESULTS:

The study cohort included 8161 recipients (2043 in EARLY D/C; 2031 in LATE D/C; and 4087 in LONG-TERM). LONG-TERM use of CS decreased over time, from 60% in 2000 to 43% in 2008, while EARLY D/C increased from 19% to 33%, respectively. Survival at 10 years after transplant was lower among the LONG-TERM group (73% vs EARLY D/C 82% vs LATE D/C 80%; P < 0.0001).

CONCLUSIONS:

In this large multinational cohort, the practice of long-term CS maintenance was associated with lower long-term survival compared with shorter CS use.

KEYWORDS:

corticosteroid; heart transplantation; immunosuppression

PMID:
29956385
DOI:
10.1111/ctr.13340

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