Effect of pre-transplantation prednisone on survival after lung transplantation

Kendra J. McAnally, Vincent G. Valentine, Stephanie G. LaPlace, Paul M. McFadden, Leonardo Seoane, David E. Taylor

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: It is routine practice to discontinue corticosteroids or at least reduce the dose to ≤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/m2 per day), and 62 had taken high-dose (HD) prednisone (≥0.42 mg/kg/m2 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 ≥0.42 mg/kg/m2 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 ≥0.42 mg/kg/m2 per day may be associated with increased complications and worse survival after lung transplantation. Further studies are warranted to confirm these results.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume25
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

Fingerprint

Lung Transplantation
Prednisone
Transplantation
Survival
Steroids
Adrenal Cortex Hormones
Lung
Idiopathic Pulmonary Fibrosis
Emphysema
Wound Healing
Body Mass Index
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

McAnally, K. J., Valentine, V. G., LaPlace, S. G., McFadden, P. M., Seoane, L., & Taylor, D. E. (2006). Effect of pre-transplantation prednisone on survival after lung transplantation. Journal of Heart and Lung Transplantation, 25(1), 67-74. https://doi.org/10.1016/j.healun.2005.07.012

Effect of pre-transplantation prednisone on survival after lung transplantation. / McAnally, Kendra J.; Valentine, Vincent G.; LaPlace, Stephanie G.; McFadden, Paul M.; Seoane, Leonardo; Taylor, David E.

In: Journal of Heart and Lung Transplantation, Vol. 25, No. 1, 01.2006, p. 67-74.

Research output: Contribution to journalArticle

McAnally, KJ, Valentine, VG, LaPlace, SG, McFadden, PM, Seoane, L & Taylor, DE 2006, 'Effect of pre-transplantation prednisone on survival after lung transplantation', Journal of Heart and Lung Transplantation, vol. 25, no. 1, pp. 67-74. https://doi.org/10.1016/j.healun.2005.07.012
McAnally, Kendra J. ; Valentine, Vincent G. ; LaPlace, Stephanie G. ; McFadden, Paul M. ; Seoane, Leonardo ; Taylor, David E. / Effect of pre-transplantation prednisone on survival after lung transplantation. In: Journal of Heart and Lung Transplantation. 2006 ; Vol. 25, No. 1. pp. 67-74.
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abstract = "Background: It is routine practice to discontinue corticosteroids or at least reduce the dose to ≤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/m2 per day), and 62 had taken high-dose (HD) prednisone (≥0.42 mg/kg/m2 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 ≥0.42 mg/kg/m2 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 ≥0.42 mg/kg/m2 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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AU - McAnally, Kendra J.

AU - Valentine, Vincent G.

AU - LaPlace, Stephanie G.

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AU - Seoane, Leonardo

AU - Taylor, David E.

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