title: Influence of steroid dosage, withdrawal, and reinstatement on survival after heart transplantation: results from the RESTCO study.
abstract: BACKGROUND
  Little information is available regarding the consequences of steroid withdrawal following heart transplantation (HT) in Spain.
  
  
  METHODS
  We analyzed the records of 1068 patients (81.6% men) who underwent HT between 2000 and 2005 in 13 Spanish centers who were aged ≥ 18 years and who survived at least 1 year. Death rates and Kaplan-Meier survival curves for 1 to 5 years post-HT were compared among four groups: groups A and B, patients on steroids throughout the first 5 years post-HT at dosages of ≤ 5 mg/d between 1-year and 5-year follow-up (group A; n = 148), or >5 mg/d for some part of this period (group B; n = 578). Groups C and D were patients from whom steroids were at some point withdrawn including group D (n = 73) with and group C (n = 269) without subsequent reintroduction into the maintenance regimen.
  
  
  RESULTS
  Steroids were withdrawn at 1.6 ± 0.9 years post-HT in group C, and 1.7 ± 1.2 years post-HT in group D. The death rate between 1- and 5-year follow-up (deaths per 1000 person-years) was 44.3% (95% confidence interval 26.2-62.5) in group A, 42.6% (33.7-51.4) in group B, 30.5% (19.6-41.4) in group C, and 47.8% (21.8-73.7) in group D. There was no significant difference among them or among Kaplan-Meier survival curves of the four groups (P = .34 in both cases). Comparison of combined groups C + D with groups A + B showed no evidence of a greater mortality among combined groups C + D.
  
  
  CONCLUSIONS
  The late withdrawal of steroids following HT was not associated with increased mortality.
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain. jdelgado.hdoc@salud.madrid.org
authors.forename: J
authors.initials: J
authors.lastname: Delgado Jiménez
authors.forename: L
authors.initials: L
authors.lastname: Almenar Bonet
authors.forename: M J
authors.initials: MJ
authors.lastname: Paniagua Martín
authors.forename: M
authors.initials: M
authors.lastname: Gómez Bueno
authors.forename: J F
authors.initials: JF
authors.lastname: Yáñez
authors.forename: J M
authors.initials: JM
authors.lastname: Arizón Del Prado
authors.forename: T
authors.initials: T
authors.lastname: Blasco Peiró
authors.forename: L
authors.initials: L
authors.lastname: de la Fuente Galán
authors.forename: I P
authors.initials: IP
authors.lastname: Garrido Bravo
authors.forename: M G
authors.initials: MG
authors.lastname: Crespo-Leiro
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents