ArticleClinical transplantation2025
Rapid Corticosteroid Withdrawal After Cardiac Transplantation Improves Outcomes.
Article in Clinical transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Unaccounted immunosuppression and absent donor data limit infection risk after high-urgency heart transplantation.ESC heart failure · 2026Article
- Rapid Corticosteroid Withdrawal After Cardiac Transplantation Improves Outcomes.Clinical transplantation · 2025Article
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11 authors.
Funding
Abstract
backgroundModern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long-term outcomes have remained limited by drug-related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti-thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high-dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months.
methodsWe evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT ≥ 2R, infection, non-cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single-center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983-1998); Recent (1999-02/2010), and Corticosteroid withdrawal (CSW) (03/2010-06/2018). Multivariate Cox analyses identified predictors of adverse outcomes.
resultsFive-year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years; p < 0.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49-4.68; Recent: HR: 2.9; 95% CI: 4.1, both p < 0.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09-1.30; p < 0.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91-3.81; p < 0.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68-3.39; p < 0.0001) were independently associated with worse outcomes in the final multivariate Cox model. Notably, death, rejection, infection, and CAV were less frequent in the CSW era.
conclusionProtocolized CSW within 1 year after HTx was associated with improved long-term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.
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