Pre-transplant corticosteroid use and outcome in lung transplantation

Background: The early experience of lung transplantation was plagued with a irway anastomotic complications. The use of corticosteroids in the pre-tran splant period has been implicated as a major contributing factor in bronchi al dehiscence, and many patients have been denied transplantation on the ba sis of corticosteroid use. We conducted the current study to assess the ris ks associated with pre-transplant corticosteroid use. Methods: We analyzed records of 73 single- and bilateral-single lung transp lant recipients who had chronic obstructive pulmonary disease or alpha (1)- antitrypsin deficiency as their underlying disease from 1986 to 1996. Twent y-six patients (steroid group) received daily corticosteroid therapy (predn isone, 1.5 to 40 mg/day) up to the time of transplantation, whereas 47 pati ents did not receive chronic corticosteroids and had no corticosteroid ther apy within 3 months of transplantation (non-steroid group). Results: The demographic profiles of the 2 groups were comparable. We noted no statistical significances in length of hospital stay, duration of inten sive care, and postoperative pulmonary function. The rates of cytomegalovir us infection, acute rejection, bronchiolitis obliterans syndrome, and survi val were also similar. The non-steroid group seemed to have a higher rate o f bronchial stenosis at 3 years (29% vs 6%, p = 0.03). Bronchial dehiscence did not occur in either study group. Conclusions: Pre-transplant use of corticosteroids does not adversely affec t outcome following lung transplantation.