Steroid use in heart transplant patients in Spain in the current era: a multicenter survey.
OBJECTIVE
Steroid withdrawal (SW) from maintenance therapy in heart transplant patients is still a controversial subject. We designed a questionnaire to ascertain the attitudes and procedures of a number of Spanish heart transplant units (16) regarding the use/withdrawal of steroids as part of the immunosuppressive maintenance therapy.


METHODS
We sent an 11-item questionnaire to the clinical director in charge of each unit. The questionnaire was completed and returned by 14 units.


RESULTS
In 21.5% of the centers SW was performed in all patients, while 78.5% of the centers only performed SW in selected patients. In 57% of units SW was performed at 12 months posttransplantation and between 6 and 12 months in the rest. Fewer than 20% of patients were steroid-free in 46% of units while in 23% of units this proportion was >50%. In 11 units, the minimum prednisone dose administered was <or=5 mg/d. More than 80% used the following selection criteria for SW: no acute rejection episodes (ARE) in the first 3 to 6 months, low immunological risk, and concomitant immunosuppression. The main expected benefits were: a decrease in the incidence of diabetes, bone problems, and obesity, and improved dyslipidemia, hypertension, and overweight. Twenty-eight percent of units performed an endomyocardial biopsy (EMB) before SW, while 3 units also repeated it after SW. In most cases (72%), an EMB was always performed at 1 month after withdrawal. In a low percentage of cases (<30%), all units had to reintroduce steroids in the maintenance regimen due to an ARE (73%).


CONCLUSIONS
Most heart transplant units (78.5%) performed SW at 1 year after transplantation in selected patients: those without an ARE in the first 3 to 6 months and those with low immunological risk. The main benefits were to avoid or reduce diabetes and bone problems, and to a lesser extent, overweight, hypertension, and hypercholesterolemia. In <30% of patients steroids had to be reintroduced due to an ARE.
Crespo-Leiro
M
M
Servicio de Cardiología, Hospital A Coruña, A Coruña, Spain. Marisa.Crespo.Leiro@sergas.es
Delgado
J
J
Almenar
L
L
Arizón
J M
JM
Blasco
T
T
Brossa
V
V
De la Fuente
L
L
Díaz
B
B
Fernández-Yañez
J
J
Garrido
I P
IP
Gómez Bueno
M
M
González Vílchez
F
F
Lage
E
E
López López
L
L
Mirabet
S
S
Pérez-Villa
F
F
Pulpón
L A
LA
Roig
E
E
Vázquez de Prada
J A
JA
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006306:Health Surveys; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D013030:Spain; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000473:pathology
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents