title: Efficacy of cyclosporine to reduce steroids in patients with idiopathic pulmonary fibrosis before lung transplantation.
abstract: Lung transplantation today is considered an effective option for patients with severe idiopathic pulmonary fibrosis. The standard medical treatment for this disease consists of high-dose steroids alone or combined with other immunosuppressive drugs. Unfortunately, pretransplantation administration of steroids may jeopardize the healing of the airway anastomosis and cause other complications; therefore it is considered a relative contraindication to lung transplantation. For this reason we try to reduce the dose of prednisone to 15 to 20 mg/day or less before the transplantation, but this creates many difficulties and is sometimes impossible in severely ill patients. Therefore we used cyclosporine (4 to 7 mg/kg/day) in 10 patients who were receiving high-dose prednisone (> or = 50 mg/day) therapy, but who were otherwise suitable candidates for lung transplantation. In seven cases prednisone could be tapered to 20 mg/day or less, allowing acceptance in our program. These patients had a CRP score of 60 or more before entering our trial and remained stable at this level after conversion to cyclosporine. The 6-minute walk test showed a mild improvement in five cases (71.5%). Three patients underwent single lung transplantation; two patients are on our waiting list after 3.5 and 4 months of treatment with cyclosporine and prednisone (10 mg/day), and two patients died while awaiting a suitable organ 6 and 7.5 months after starting cyclosporine therapy. Combined administration of cyclosporine and prednisone may extend the waiting time while receiving low-dose steroids and allow more patients with idiopathic pulmonary fibrosis to qualify for lung transplantation while reducing the risk of steroid-induced complications.
authors.affiliation: University of Rome La Sapienza, Department of Thoracic Surgery, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Venuta
authors.forename: E A
authors.initials: EA
authors.lastname: Rendina
authors.forename: P
authors.initials: P
authors.lastname: Ciriaco
authors.forename: T
authors.initials: T
authors.lastname: De Giacomo
authors.forename: E
authors.initials: E
authors.lastname: Pompeo
authors.forename: A
authors.initials: A
authors.lastname: Bachetoni
authors.forename: C
authors.initials: C
authors.lastname: Ricci
mesh_terms: D000328:Adult; D000075202:Contraindications; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D011658:Pulmonary Fibrosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D015656:Respiratory Mechanics
chemical_list: D016572:Cyclosporine; D011241:Prednisone