title: Indicators for steroid response in biopsy proven acute graft rejection after lung transplantation.
abstract: OBJECTIVE
  Acute rejection (AR) after lung transplantation (LTx) requires prompt intervention. Most episodes respond to steroid pulse therapy. The aim of this study was to evaluate clinical indicators for non-response to steroid treatment in biopsy proven AR after the early postoperative period.
  
  
  METHODS
  We prospectively analysed 85 patients more than 6 months after LTx with symptomatic biopsy proven AR (>or=grade A1) from Jan. 2005 until Nov. 2007 in a single centre. In 47 patients, AR was steroid-sensitive (group 1), 38 patients did not respond to steroid pulse therapy (group 2). All AR episodes were associated with clinical symptoms. Fifty-seven (67%) were low-grade rejections (ISHLT A1).
  
  
  RESULTS
  Independent clinical predictors for steroid response vs. non-steroid response in biopsy proven AR were "days after transplantation" (p=0.01, adjusted hazard ratio (HR) 1.2), "decline in home spirometry slope" (p=0.03, HR 0.97), "adherence to home spirometry" (p=0.05, HR 0.98) and "serum CRP" (p=0.02, HR 0.87). Eight patients (21%) of group 2 developed BOS during the following 6 months.
  
  
  CONCLUSIONS
  Early detection of deterioration in graft function seems to be crucial for effective treatment of AR. Home spirometry seems to be useful in detecting early changes in graft function and surveillance protocols could be potentially helpful in predicting patients likely to demonstrate a steroid response.
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. fuehner.thomas@mh-hannover.de
authors.forename: T
authors.initials: T
authors.lastname: Fuehner
authors.forename: A
authors.initials: A
authors.lastname: Simon
authors.forename: M
authors.initials: M
authors.lastname: Dierich
authors.forename: C
authors.initials: C
authors.lastname: Dewall
authors.forename: F
authors.initials: F
authors.lastname: Laenger
authors.forename: M W
authors.initials: MW
authors.lastname: Pletz
authors.forename: T
authors.initials: T
authors.lastname: Welte
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D016040:Lung Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012129:Respiratory Function Tests; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013256:Steroids