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

J Heart Lung Transplant. 2015 Aug;34(8):1066-72. doi: 10.1016/j.healun.2015.03.003. Epub 2015 Mar 20.


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.

Keywords: corticosteroid; heart transplantation; pediatric; propensity score; rejection.

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Databases, Factual
  • Drug Administration Schedule
  • Female
  • Graft Rejection / epidemiology
  • Graft Rejection / prevention & control*
  • Graft Survival
  • Heart Failure / mortality
  • Heart Failure / surgery*
  • Heart Transplantation*
  • Humans
  • Immunosuppression Therapy
  • Incidence
  • Infant
  • Kaplan-Meier Estimate
  • Male
  • Propensity Score
  • Retrospective Studies
  • Risk Factors
  • Steroids / administration & dosage*
  • Treatment Outcome


  • Steroids