title: Moderate-dose glucocorticoids as salvage therapy for severe pneumonia in renal transplant recipients: a single-center feasibility study.
abstract: This study aimed to assess the effectiveness and safety of moderate-dose glucocorticoids (GCs) with mechanical ventilation as salvage therapy for renal transplant recipients with severe pneumonia, which was non-responsive to conventional treatment. A retrospective study was conducted involving renal transplant recipients diagnosed with severe pneumonia and did not respond to conventional treatment. All immunosuppressants were then completely withdrawn, and the patients were initially administered with methylprednisolone at doses of 2.0-2.5 mg/kg/day once every 12 h. This dosage was continued until oxygenation improved, and the treatment was gradually tapered (by 20 mg every 2-3 days) to the previous maintenance dosage. Ten patients were recruited from year 2008 to 2012. Two patients who underwent emergency endotracheal intubation were intubated on days 3 and 8, respectively, another one died from recurrent pneumothorax. The mean PaO2/FiO2 of the nine survivors was significantly increased by the increasing treatment duration; whereas the lung injury scores (LIS) and the sequential organ failure assessment (SOFA) score were both significantly decreased. The use of moderate-dose GCs may play a role as salvage therapy for renal transplant recipients with severe pneumonia. However, further study with larger trials to is needed.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Unit, Zhongshan Hospital, Fudan University , Shanghai , China .
authors.forename: Guo-Wei
authors.initials: GW
authors.lastname: Tu
authors.forename: Min-Jie
authors.initials: MJ
authors.lastname: Ju
authors.forename: Yan
authors.initials: Y
authors.lastname: Han
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: He
authors.forename: Rui-Ming
authors.initials: RM
authors.lastname: Rong
authors.forename: Ming
authors.initials: M
authors.lastname: Xu
authors.forename: Zhang-Gang
authors.initials: ZG
authors.lastname: Xue
authors.forename: Tong-Yu
authors.initials: TY
authors.lastname: Zhu
authors.forename: Zhe
authors.initials: Z
authors.lastname: Luo
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003428:Cross Infection / Q000188:drug therapy; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007442:Intubation, Intratracheal; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008775:Methylprednisolone