title: Steroid avoidance in pediatric heart transplantation results in excellent graft survival.
abstract: BACKGROUND
  Maintenance steroid (MS) use in pediatric heart transplantation (HT) varies across centers. The purpose of this study was to evaluate the impact of steroid-free maintenance immunosuppression (SF) on graft outcomes in pediatric HT.
  
  
  METHODS
  Patients younger than 18 years in the United States undergoing a first HT during 1990 to 2010 were analyzed for conditional 30-day graft loss (death or repeat HT) and death based on MS use by multivariable analysis. A propensity score was then given to each patient using a logistic model, and propensity matching was performed using pre-HT risk factors, induction therapy, and nonsteroid maintenance immunosuppression. Kaplan-Meier graft and patient survival probabilities by MS use were then calculated.
  
  
  RESULTS
  Of 4894 patients, 3962 (81%) were taking MS and 932 (19%) SF. Of the 4530 alive at 30 days after HT, 3694 (82%) and 836 (18%) were in the MS and SF groups, respectively. Unmatched multivariable analysis showed no difference in 30-day conditional graft survival between MS and SF groups (hazard ratio=1.08, 95% confidence interval=0.93-1.24; P=0.33). Propensity matching resulted in 462 patients in each MS and SF group. Propensity-matched Kaplan-Meier survival analysis showed no difference in graft or patient survival between groups (P=0.3 and P=0.16, respectively).
  
  
  CONCLUSIONS
  We found no difference in graft survival between SF patients and those taking MS. An SF regimen in pediatric HT avoids potential complications of steroid use without compromising graft survival, even after accounting for pre-HT risk factors.
authors.affiliation: 1 Pediatrics, Division of Pediatric Cardiology, School of Medicine, University of Colorado Aurora, CO. 2 Pediatrics, Children's Hospital Research Institute, School of Medicine, University of Colorado Aurora, CO. 3 Pediatric Cardiac Surgery, School of Medicine, University of Colorado Aurora, CO. 4 Address correspondence to: Scott R. Auerbach, M.D., School of Medicine, University of Colorado Denver, Children's Hospital Colorado Heart Institute, 13123 E 16th Ave, B100 Aurora, CO 80238.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Auerbach
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
authors.forename: David N
authors.initials: DN
authors.lastname: Campbell
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Miyamoto
authors.forename: Biagio A
authors.initials: BA
authors.lastname: Pietra
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids