Steroid Withdrawal During 5 Years Following Heart Transplantation, and the Relationship Between Steroid Dosage at 1-Year Follow-up and Complications During the Next 2 Years: Results From the RESTCO Study
Por:
Leiro, MGC, Bonet, LA, Martin, MJP, Bueno, MG, Escribano, P, Vilchez, FG, Lambert, JLR, Loidi, VB, Gelle, EL, Jimenez, JD
Publicada:
1 nov 2012
Resumen:
Background. Little information is available regarding the controversial issue of steroid withdrawal following heart transplantation (HT), or instead in the incidence of adverse steroid effects at dosages typically employed in Spain.
Methods. We analyzed the 5-year follow-up records of 1209 patients (82.5% men, aged >= 18 years) who underwent FIT between 2000 and 2005 and survived at least 1 month in 13 Spanish centers. The incidences of first steroid withdrawal before 1, 3, and 5 years post-HT were expressed as Kaplan-Meier probability estimates. Three patient groups defined in accordance with steroid dosage at 1-year follow-up (0, <= 5, and >5 mg/d; groups A, B, and C, respectively) were compared with regard to the incidence of de novo hypertension, diabetes, and bone fractures over the following 2 years.
Results. The 5-year incidence of withdrawal was 28%, 21% of whom required reintroduction of steroids. Kaplan-Meier probabilities of withdrawal before 1, 3, and 5 years post-HT were 8.8% (95% confidence interval ([CI] 7.3%-10.7%), 27.8% (CI 25.2%-30.6%), and 30.2% (CI 27.5%-33.2%), respectively. At 1-year follow-up, 9.9% of patients were steroid-free, 28.9% were taking <= 5 mg/d, and 61.3% >5 mg/d. The 2-year incidence of de novo hypertension increased significantly (P = .012) from 13.5% to 29.6% to 35.3% in groups A, B, and C respectively. These groups did not differ significantly in regard to the 2-year incidence of diabetes or bone fractures.
Conclusions. Reintroduction of steroids was required by 21% of the 28% of Spanish HT patients who has been weaned from steroids within 5 years of FIT. The incidence of de novo hypertension between 1 and 3 years post-HT increased with steroid dosage at 1-year follow-up. De novo diabetes and bone fractures showed no similar significant association.
Filiaciones:
Leiro, MGC:
Univ A Coruna, Complejo Hosp, La Coruna, Spain
Bonet, LA:
Hosp Univ & Politecn La Fe, Valencia, Spain
Martin, MJP:
Univ A Coruna, Complejo Hosp, La Coruna, Spain
Bueno, MG:
Univ Puerta Madrid, Madrid, Spain
Escribano, P:
Hosp Univ 12 Octubre, Madrid, Spain
Vilchez, FG:
Hosp Univ Marques de Valdecilla, Santander, Spain
Lambert, JLR:
Hosp Univ Cent Asturias, Austrias, Spain
Loidi, VB:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gelle, EL:
Hosp Univ Virgen del Rocio, Seville, Spain
Jimenez, JD:
Hosp Univ 12 Octubre, Madrid, Spain
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