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  • Title: Effect of pre-transplantation prednisone on survival after lung transplantation.
    Author: McAnally KJ, Valentine VG, LaPlace SG, McFadden PM, Seoane L, Taylor DE.
    Journal: J Heart Lung Transplant; 2006 Jan; 25(1):67-74. PubMed ID: 16399533.
    Abstract:
    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.
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