{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:28:52Z","timestamp":1783211332569,"version":"3.54.6"},"reference-count":42,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Modern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long\u2010term outcomes have remained limited by drug\u2010related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti\u2010thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high\u2010dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT \u2265\u00a02R, infection, non\u2010cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single\u2010center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983\u20131998); Recent (1999\u201302\/2010), and Corticosteroid withdrawal (CSW) (03\/2010\u201006\/2018). Multivariate Cox analyses identified predictors of adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five\u2010year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49\u20134.68; Recent: HR: 2.9; 95% CI: 4.1, both\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09\u20131.30;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91\u20133.81;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68\u20133.39;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Protocolized CSW within 1 year after HTx was associated with improved long\u2010term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70420","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:53:37Z","timestamp":1765976017000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rapid Corticosteroid Withdrawal After Cardiac Transplantation Improves Outcomes"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7589-2076","authenticated-orcid":false,"given":"Claudia","family":"Minato","sequence":"first","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine","family":"Nasri","sequence":"additional","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre\u2010Emmanuel","family":"Noly","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Surgery Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinthe","family":"Boulet","sequence":"additional","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u2010Claude","family":"Parent","sequence":"additional","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annik","family":"Fortier","sequence":"additional","affiliation":[{"name":"Montreal Health Innovations Coordinating Center (MHICC)  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"de Denus","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Universit\u00e9 De Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Tremblsay\u2010Gravel","sequence":"additional","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevi\u00e8ve","family":"Giraldeau","sequence":"additional","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoan","family":"Lamarche","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Surgery Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anique","family":"Ducharme","sequence":"additional","affiliation":[{"name":"Departments of Medicine Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042018816641580"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2008.00868.x"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00765.x"},{"issue":"10","key":"e_1_2_11_5_1","first-page":"1039","article-title":"Improved Long\u2010Term Survival After Heart Transplantation Predicted by Successful Early Withdrawal From Maintenance Corticosteroid Therapy","volume":"15","author":"Taylor D. 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