Rapid Corticosteroid Withdrawal After Cardiac Transplantation Improves Outcomes
Bibliographic record
Abstract
BACKGROUND: Modern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long-term outcomes have remained limited by drug-related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti-thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high-dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months. METHODS: We evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT ≥ 2R, infection, non-cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single-center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983-1998); Recent (1999-02/2010), and Corticosteroid withdrawal (CSW) (03/2010-06/2018). Multivariate Cox analyses identified predictors of adverse outcomes. RESULTS: Five-year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years; p < 0.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49-4.68; Recent: HR: 2.9; 95% CI: 4.1, both p < 0.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09-1.30; p < 0.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91-3.81; p < 0.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68-3.39; p < 0.0001) were independently associated with worse outcomes in the final multivariate Cox model. Notably, death, rejection, infection, and CAV were less frequent in the CSW era. CONCLUSION: Protocolized CSW within 1 year after HTx was associated with improved long-term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".