Effect of pre-transplantation prednisone on survival after lung transplantation.
BACKGROUND
It is routine practice to discontinue corticosteroids or at least reduce the dose to <or=20 mg/day in patients being considered for lung transplantation. No studies have either evaluated the risks of pre-transplantation steroid use or determined safe or optimal doses in the pre- or post-lung transplantation time frame. We sought to determine whether there are deleterious effects of prednisone administration before lung transplantation and if corticosteroids affect survival after lung transplantation.


METHODS
Between November 1990 and January 2005, 201 patients underwent lung transplantation. Of these, 126 patients had been prescribed prednisone before lung transplantation. Sixty-four had taken low-dose (LD) prednisone (<0.42 mg/kg/m(2) per day), and 62 had taken high-dose (HD) prednisone (>or=0.42 mg/kg/m(2) per day). The LD Group also included 75 patients never prescribed steroids before lung transplantation (n = 139).


RESULTS
A comparison of survival rates between LD and HD Cohorts showed better survival in the LD group, p value by log rank for LD vs HD <0.01. Other than having more emphysema patients (53/139, 40%) and fewer idiopathic pulmonary fibrosis patients (21/139, 16%) in the LD group (p < 0.01), pre-transplantation characteristics between the 2 cohorts were similar. In addition, the LD Group had more bilateral lung recipients (p < 0.01). During the first 100 days after transplantation, 20 HD (20/62) patients and 16 LD (16/139) died (p < 0.01).


CONCLUSIONS
Survival in the LD Cohort was strikingly better than for patients receiving >or=0.42 mg/kg/m(2) per day. Deaths in the early post-operative period for the HD Group may be related to steroid-induced complications such as poor wound healing and serious infections. A pre-lung transplantation steroid dose adjusted for body mass index of >or=0.42 mg/kg/m(2) per day may be associated with increased complications and worse survival after lung transplantation. Further studies are warranted to confirm these results.
McAnally
Kendra J
KJ
Lung Transplantation, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
Valentine
Vincent G
VG
LaPlace
Stephanie G
SG
McFadden
Paul M
PM
Seoane
Leonardo
L
Taylor
David E
DE
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D007239:Infections / Q000209:etiology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014945:Wound Healing
D007166:Immunosuppressive Agents; D011241:Prednisone