Continuation Of Corticosteroids 1-Year After Adult Heart Transplantation Is Associated With Worse Outcomes: Findings From The ISHLT Registry.

While long-term immunosuppression has drastically improved heart transplant (HT) viability, resultant side effects might contribute to morbidity and mortality. Discontinuation of corticosteroids might be feasible without adversely affecting outcomes. We compared outcomes in adult HT recipients with or without steroids 1-year post-transplant in a large, international registry. We reviewed adults (age ≥ 18 years) who underwent their first heart-only transplantation between January 2010 and June 2018 in the ISHLT database with follow-up through April 2019 who were discharged from the hospital on steroids. We divided the cohort into those with or without steroids by their 1-year follow-up. Those who died or who lacked information on steroid use by 1 year were excluded. We compared the risk-adjusted 2-, 3-, and 5-year survival as well as the development of coronary allograft vasculopathy (CAV), treated rejection within 2-years, diabetes, malignancy, and severe renal dysfunction after transplant. We identified 17,483 HT recipients, 8,750 (50.0%) of whom stopped steroids 1-year post-HT. Those who were receiving steroids were significantly younger, more likely female, had a higher BMI, higher IABP and LVAD use before HT, worse renal function, and slightly longer ischemic time. Survival rates (conditional on 1-year survival) significantly differed between the steroid and non-steroid groups 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)(Figure). After adjusting for factors such as recipient age, BMI, history of diabetes, and HF etiology among others, continuation of steroids was 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 also associated with significantly a higher odds of CAV (OR 1.09, 95% CI 1.01-1.18), diabetes (OR 1.23, 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) with no difference in malignancy rates (OR 0.85, 95% CI 0.70-1.04). Continuation of corticosteroid 1-year after heart transplant was associated with significantly lower survival and greater adverse outcomes among the heart transplant recipients enrolled in the ISHLT registry. [ABSTRACT FROM AUTHOR]