Jaiswal Abhishek, Baker William L, Pillai Ashwin, Kittleson Michelle, Mogga Balaphanidhar, Jedeon Zeina, Chen Caroline, Baran David A
Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CT.
University of Connecticut School of Pharmacy, Department of Pharmacy Practice, Storrs, CT.
JHLT Open. 2025 Jan 17;8:100214. doi: 10.1016/j.jhlto.2025.100214. eCollection 2025 May.
Immunosuppressive drugs ensure graft survival in heart transplantation (HT). However, prolonged use can lead to significant morbidity and mortality, and the optimal immunosuppressive regimen is unknown. We compared outcomes in adult HT recipients with or without steroid use in the large, international ISHLT Registry.
We included adults who underwent their first heart-only transplant between January 2010 and June 2018. We compared the risk-adjusted 2-, 3-, and 5-year survival as well as coronary allograft vasculopathy (CAV), treated rejection within 2 years, severe renal dysfunction, diabetes and malignancy rates between those with and without steroids by 1-year post-HT follow-up.
We included 17,483 HT recipients, steroids were discontinued in 8750 (50.0%) recipients beyond 1-year post-HT. Unadjusted survival rates (conditional upon 1-year survival) were significantly lower in the cohort receiving steroids at 2-years (96.2% vs. 98.0%, p<0.001), 3-years (93.3% vs. 96.5% p<0.001), and 5-years (89.8% vs. 94.0%, p<0.001). After adjustment, continued steroid use remained associated with a significantly higher risk of 2-year (HR 1.92, 95% CI 1.60-2.31), 3-year (HR 1.88, 95% CI 1.63-2.16), and 5-year mortality (HR 1.64, 95% CI 1.47-1.82). Furthermore, continuing steroid was associated with a significantly higher prevalence of CAV (OR 1.09, 95% CI 1.01-1.18), diabetes (OR 1.24, 95% CI 1.12-1.36), 2-year treated rejection (OR 2.50, 95% CI 2.25-2.73), and severe renal dysfunction (OR 1.66, 95% CI 1.50-1.84) but no difference in malignancy rates (OR 0.85, 95% CI 0.70-1.04).
Steroid use beyond 1year post heart transplant was associated with significantly lower survival, and worsened morbidity among adult recipients. Whether this observation indicates steroid use is a marker of higher risk or worsens prognosis warrants prospective investigation.
免疫抑制药物可确保心脏移植（HT）中移植物的存活。然而，长期使用会导致显著的发病率和死亡率，且最佳免疫抑制方案尚不清楚。我们在大型国际心脏移植学会（ISHLT）登记处比较了成年心脏移植受者使用或不使用类固醇的结果。
我们纳入了2010年1月至2018年6月期间接受首次单纯心脏移植的成年人。通过心脏移植术后1年的随访，我们比较了使用和未使用类固醇的患者经风险调整后的2年、3年和5年生存率，以及冠状动脉移植血管病变（CAV）、2年内治疗的排斥反应、严重肾功能不全、糖尿病和恶性肿瘤发生率。
我们纳入了17483名心脏移植受者，8750名（50.0%）受者在心脏移植术后1年以上停用了类固醇。在2年时（96.2%对98.0%，p<0.001）、3年时（93.3%对96.5%，p<0.001）和5年时（89.8%对94.0%，p<0.001），使用类固醇的队列中未经调整的生存率（以1年生存率为条件）显著较低。调整后，继续使用类固醇仍与2年（风险比[HR]1.92，95%置信区间[CI]1.60 - 2.31）、3年（HR 1.88，95% CI 1.63 - 2.16）和5年死亡率（HR 1.64，95% CI 1.47 - 1.82）的显著更高风险相关。此外，继续使用类固醇与CAV（优势比[OR]1.09，95% CI 1.01 - 1.18）、糖尿病（OR 1.24，95% CI 1.12 - 1.36）、2年治疗的排斥反应（OR 2.50，95% CI 2.25 - 2.73）和严重肾功能不全（OR 1.66，95% CI 1.50 - 1.84）的显著更高患病率相关，但恶性肿瘤发生率无差异（OR 0.85，95% CI 0.70 - 1.04）。
心脏移植术后1年以上使用类固醇与成年受者生存率显著降低和发病率恶化相关。这一观察结果表明类固醇使用是更高风险的标志还是会恶化预后，值得进行前瞻性研究。
