Effect of pre-transplantation prednisone on survival after lung transplantation

J Heart Lung Transplant. 2006 Jan;25(1):67-74. doi: 10.1016/j.healun.2005.07.012. Epub 2005 Nov 10.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Body Mass Index
  • Body Weight
  • Child
  • Cohort Studies
  • Female
  • Graft Rejection
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects*
  • Infections / etiology
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prednisone / administration & dosage*
  • Prednisone / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Wound Healing


  • Immunosuppressive Agents
  • Prednisone