Efficacy of cyclosporine to reduce steroids in patients with idiopathic pulmonary fibrosis before lung transplantation

J Heart Lung Transplant. Nov-Dec 1993;12(6 Pt 1):909-14.

Abstract

Lung transplantation today is considered an effective option for patients with severe idiopathic pulmonary fibrosis. The standard medical treatment for this disease consists of high-dose steroids alone or combined with other immunosuppressive drugs. Unfortunately, pretransplantation administration of steroids may jeopardize the healing of the airway anastomosis and cause other complications; therefore it is considered a relative contraindication to lung transplantation. For this reason we try to reduce the dose of prednisone to 15 to 20 mg/day or less before the transplantation, but this creates many difficulties and is sometimes impossible in severely ill patients. Therefore we used cyclosporine (4 to 7 mg/kg/day) in 10 patients who were receiving high-dose prednisone (> or = 50 mg/day) therapy, but who were otherwise suitable candidates for lung transplantation. In seven cases prednisone could be tapered to 20 mg/day or less, allowing acceptance in our program. These patients had a CRP score of 60 or more before entering our trial and remained stable at this level after conversion to cyclosporine. The 6-minute walk test showed a mild improvement in five cases (71.5%). Three patients underwent single lung transplantation; two patients are on our waiting list after 3.5 and 4 months of treatment with cyclosporine and prednisone (10 mg/day), and two patients died while awaiting a suitable organ 6 and 7.5 months after starting cyclosporine therapy. Combined administration of cyclosporine and prednisone may extend the waiting time while receiving low-dose steroids and allow more patients with idiopathic pulmonary fibrosis to qualify for lung transplantation while reducing the risk of steroid-induced complications.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Contraindications
  • Cyclosporine / administration & dosage*
  • Female
  • Humans
  • Infections / etiology
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prednisone / administration & dosage*
  • Prednisone / adverse effects
  • Preoperative Care*
  • Pulmonary Fibrosis / drug therapy
  • Pulmonary Fibrosis / physiopathology
  • Pulmonary Fibrosis / surgery*
  • Respiratory Mechanics

Substances

  • Cyclosporine
  • Prednisone