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

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 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.