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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(s) -
Goldraich Livia A.,
Stehlik Josef,
Cherikh Wida S.,
Edwards Leah B.,
Urban Read,
Dipchand Anne,
Ross Heather J.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13340
Subject(s) - medicine , heart transplantation , transplantation , immunosuppression , lung transplantation , cohort , cohort study , survival analysis , proportional hazards model , surgery , pediatrics
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.