title: The safety of low-dose prednisone before and immediately after heart-lung transplantation.
abstract: Preoperative steroid use has been considered a contraindication to heart-lung as well as lung transplantation. Moreover, most centers delay prednisone administration until 2 to 3 weeks postoperatively until airway healing is secure. We have performed 19 heart-lung transplantations and four single-lung transplantations since 1983. Five recipients (4 heart-lung, 1 single lung) had received prednisone, 5 to 40 mg daily, for 2 to 10 years preoperatively. All recipients were administered prednisone, 0.5 mg/kg daily, starting on postoperative day 1, with a taper to 0.2 mg/kg daily by 4 weeks. Minnesota antilymphocyte globulin (for 10 days), cyclosporine, and azathioprine were also employed. Bronchoscopy, lavage, and transbronchial biopsies were performed every 2 weeks for 3 months postoperatively. No patient had a serious airway complication; 2 heart-lung recipients, not on prednisone preoperatively, had a minor tracheal slough detected on bronchoscopy that resolved spontaneously. Actuarial survival after heart-lung transplantation is 84% +/- 8% and 69% +/- 16% at 1 year and 2 years, respectively. We conclude that prednisone commencing at a dose of 0.5 mg/kg daily from the first postoperative day is a safe practice after heart-lung transplantation. The long-term use of low-dose prednisone before heart-lung transplantation does not preclude normal tracheal healing. The safety of prednisone before and immediately after single-lung transplantation awaits confirmation by further experience.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, University Hospital, London, Ontario, Canada.
authors.forename: R J
authors.initials: RJ
authors.lastname: Novick
authors.forename: A H
authors.initials: AH
authors.lastname: Menkis
authors.forename: F N
authors.initials: FN
authors.lastname: McKenzie
authors.forename: K R
authors.initials: KR
authors.lastname: Reid
authors.forename: P W
authors.initials: PW
authors.lastname: Pflugfelder
authors.forename: W J
authors.initials: WJ
authors.lastname: Kostuk
authors.forename: D
authors.initials: D
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D001980:Bronchi / Q000473:pathology; D001999:Bronchoscopy; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D016041:Heart-Lung Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011241:Prednisone / Q000627:therapeutic use*; D013529:Surgical Wound Dehiscence / Q000139:chemically induced; D015996:Survival Rate; D007507:Therapeutic Irrigation; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D011241:Prednisone