Steroid use in heart transplant patients in Spain in the current era: a multicenter survey

Steroid withdrawal (SW) from maintenance therapy in heart transplant patients is still a controversial subject. We designed a questionnaire to ascertain the attitudes and procedures of a number of Spanish heart transplant units (16) regarding the use/withdrawal of steroids as part of the immunosuppressive maintenance therapy.

We sent an 11-item questionnaire to the clinical director in charge of each unit. The questionnaire was completed and returned by 14 units.

In 21.5% of the centers SW was performed in all patients, while 78.5% of the centers only performed SW in selected patients. In 57% of units SW was performed at 12 months posttransplantation and between 6 and 12 months in the rest. Fewer than 20% of patients were steroid-free in 46% of units while in 23% of units this proportion was >50%. In 11 units, the minimum prednisone dose administered was

Most heart transplant units (78.5%) performed SW at 1 year after transplantation in selected patients: those without an ARE in the first 3 to 6 months and those with low immunological risk. The main benefits were to avoid or reduce diabetes and bone problems, and to a lesser extent, overweight, hypertension, and hypercholesterolemia. In <30% of patients steroids had to be reintroduced due to an ARE.