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

Abstract

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. Primary adult heart recipients transplanted between 2000 and 2008 who survived at least 5years were categorized into three groups according to CS use: early withdrawal (≤2years) (EARLY D/C), late withdrawal (between 2 and 5years) (LATE D/C), or long-term use (>5years) (LONG-TERM). Recipient and donor characteristics, post-transplant morbidities, and mortality were compared among groups. Kaplan-Meier was used to estimate survival up to 10years post-transplant. 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 10years after transplant was lower among the LONG-TERM group (73% vs EARLY D/C 82% vs LATE D/C 80%; P<0.0001). In this large multinational cohort, the practice of long-term CS maintenance was associated with lower long-term survival compared with shorter CS use.