Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry
Introduction: 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 larg...
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Elsevier
2025-05-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000096 |
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| author | Abhishek Jaiswal, MD William L. Baker, Pharm.D Ashwin Pillai, MD Michelle Kittleson, MD, PhD Balaphanidhar Mogga, MD Zeina Jedeon, MD Caroline Chen David A. Baran, MD |
| author_facet | Abhishek Jaiswal, MD William L. Baker, Pharm.D Ashwin Pillai, MD Michelle Kittleson, MD, PhD Balaphanidhar Mogga, MD Zeina Jedeon, MD Caroline Chen David A. Baran, MD |
| author_sort | Abhishek Jaiswal, MD |
| collection | DOAJ |
| description | Introduction: 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. Methods: 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. Results: 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). Conclusions: 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. |
| format | Article |
| id | doaj-art-e3994f3fa5e04e6cb64e3fa8e262269d |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-e3994f3fa5e04e6cb64e3fa8e262269d2025-02-06T05:13:09ZengElsevierJHLT Open2950-13342025-05-018100214Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registryAbhishek Jaiswal, MD0William L. Baker, Pharm.D1Ashwin Pillai, MD2Michelle Kittleson, MD, PhD3Balaphanidhar Mogga, MD4Zeina Jedeon, MD5Caroline Chen6David A. Baran, MD7Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CT; Corresponding author: Abhishek Jaiswal, Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Suite-Seymour Street, Hartford, CT-06106.University of Connecticut School of Pharmacy, Department of Pharmacy Practice, Storrs, CTHartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CTDivision of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CADepartment of Internal Medicine, St Vincent’s Medical Center, Frank H Netter School of Medicine/Quinnipiac University, Bridgeport, CTHartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CTUniversity of Connecticut School of Pharmacy, Department of Pharmacy Practice, Storrs, CTCleveland Clinic, Heart, Vascular and Thoracic Institute, Advanced Heart Failure Program, Weston, FLIntroduction: 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. Methods: 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. Results: 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). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2950133425000096Heart transplantSteroidCorticosteroidWithdrawalDiscontinuationSurvival |
| spellingShingle | Abhishek Jaiswal, MD William L. Baker, Pharm.D Ashwin Pillai, MD Michelle Kittleson, MD, PhD Balaphanidhar Mogga, MD Zeina Jedeon, MD Caroline Chen David A. Baran, MD Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry JHLT Open Heart transplant Steroid Corticosteroid Withdrawal Discontinuation Survival |
| title | Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry |
| title_full | Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry |
| title_fullStr | Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry |
| title_full_unstemmed | Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry |
| title_short | Corticosteroid use beyond 1-year post heart transplantation is associated with worse outcomes: A contemporary analysis of the ISHLT registry |
| title_sort | corticosteroid use beyond 1 year post heart transplantation is associated with worse outcomes a contemporary analysis of the ishlt registry |
| topic | Heart transplant Steroid Corticosteroid Withdrawal Discontinuation Survival |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000096 |
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