Effect of pre-transplantation prednisone on survival after lung transplantation.

BACKGROUND: It is routine practice to discontinue corticosteroids or at least reduce the dose to 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.