title: Maintenance steroid use at 30 days post-transplant and outcomes of pediatric heart transplantation: A propensity matched analysis of the Pediatric Heart Transplant Study database.
abstract: BACKGROUND
  Maintenance steroid (MS) use in pediatric heart transplantation is variable. The purpose of this study was to evaluate the impact of MS use on graft outcomes.
  
  
  METHODS
  All patients <18 years old in the Pediatric Heart Transplant Study database at the time of first heart transplant between 1993 and 2011 who survived ≥30 days post-transplant and were from centers with a protocolized approach to MS use were included (N = 2,178). Patients were grouped by MS use at 30 days post-transplant as MS+ or MS- (no MS use). Propensity score analysis was used to generate matched groups of MS+ and MS- patients based on pre-transplant and peri-transplant factors. Kaplan-Meier survival analysis was used to compare freedom from graft loss, graft loss secondary to rejection, rejection, rejection with severe hemodynamic compromise (RSHC), malignancy, and infection between groups.
  
  
  RESULTS
  Of patients, 1,393 (64%) were MS+ and 785 (36%) were MS-. There were 315 MS- patients who had propensity matched MS+ controls. Kaplan-Meier estimates showed no difference in graft loss (p = 0.9) or graft loss secondary to rejection (p = 0.09). At 1 year post-transplant, there was no difference in freedom from rejection (p = 0.15) or malignancy (p = 0.07), but there was lower freedom from RSHC and infection in the MS- group (p = 0.05 and p = 0.02, respectively).
  
  
  CONCLUSIONS
  MS use at 30 days post-transplant was not associated with enhanced graft survival after pediatric heart transplant. MS- patients had a higher incidence of RSHC and infection. These risks should be taken into consideration when determining MS use for pediatric recipients of heart transplants.
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado Heart Institute, Aurora, Colorado. Electronic address: scott.auerbach@childrenscolorado.org.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Auerbach
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Manisha
authors.initials: M
authors.lastname: Kukreja
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado Heart Institute, Aurora, Colorado.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gilbert
authors.affiliation: Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Heather
authors.initials: H
authors.lastname: Bastardi
authors.affiliation: Department of Pediatrics, Division of Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors.forename: Brian
authors.initials: B
authors.lastname: Feingold
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Knecht
authors.affiliation: Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California.
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Brown
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado Heart Institute, Aurora, Colorado.
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D013256:Steroids
keywords: corticosteroid; heart transplantation; pediatric; propensity score; rejection