Delgado Jiménez J, Almenar Bonet L, Paniagua Martín M J, Gómez Bueno M, Yáñez J F, Arizón Del Prado J M, Blasco Peiró T, de la Fuente Galán L, Garrido Bravo I P, Crespo-Leiro M G
Hospital Universitario 12 de Octubre, Madrid, Spain.
Transplant Proc. 2012 Nov;44(9):2679-81. doi: 10.1016/j.transproceed.2012.09.074.
Little information is available regarding the consequences of steroid withdrawal following heart transplantation (HT) in Spain.
We analyzed the records of 1068 patients (81.6% men) who underwent HT between 2000 and 2005 in 13 Spanish centers who were aged ≥ 18 years and who survived at least 1 year. Death rates and Kaplan-Meier survival curves for 1 to 5 years post-HT were compared among four groups: groups A and B, patients on steroids throughout the first 5 years post-HT at dosages of ≤ 5 mg/d between 1-year and 5-year follow-up (group A; n = 148), or >5 mg/d for some part of this period (group B; n = 578). Groups C and D were patients from whom steroids were at some point withdrawn including group D (n = 73) with and group C (n = 269) without subsequent reintroduction into the maintenance regimen.
Steroids were withdrawn at 1.6 ± 0.9 years post-HT in group C, and 1.7 ± 1.2 years post-HT in group D. The death rate between 1- and 5-year follow-up (deaths per 1000 person-years) was 44.3% (95% confidence interval 26.2-62.5) in group A, 42.6% (33.7-51.4) in group B, 30.5% (19.6-41.4) in group C, and 47.8% (21.8-73.7) in group D. There was no significant difference among them or among Kaplan-Meier survival curves of the four groups (P = .34 in both cases). Comparison of combined groups C + D with groups A + B showed no evidence of a greater mortality among combined groups C + D.
The late withdrawal of steroids following HT was not associated with increased mortality.
