Transplantation: Preconditions and Outcomes in Lung Transplantation |

Influence of Steroids Medication on Clinical Outcome of Lung Transplantation FREE TO VIEW

Bo Young Lee, MD; Tae Sun Shim, MD; Kyung-Wook Jo, MD; Sang-bum Hong, MD
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Asan Medical Center, Seoul, Korea (the Republic of)

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1312A. doi:10.1016/j.chest.2016.08.1428
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SESSION TITLE: Preconditions and Outcomes in Lung Transplantation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Lung transplantation is an emerging therapeutic option for end-stage lung disease. While steroids are not absolutely contraindicated for lung transplantation candidates, previous guideline recommended to maintain prednisolone lower than 20mg if possible. However, since 2006, the recommended dose for steroids was disappeared from guidelines due to many controversial study results. Because, the cessation of steroids is not feasible in many patients with end-stage lung disease, the present study aimed to compare clinical outcomes of Lung transplantation patients according to their steroids use.

METHODS: Patients who underwent Lung transplantation were retrospectively reviewed in single tertiary referral center from Oct 2008 to Dec 2015. The survival outcome was compared between those who discontinued steroids at least 3 weeks before transplant (non-steroid group) and those who did not (steroid group).

RESULTS: Among forty-one patients who received lung transplant, 3 children patients and 2 patients with concurrent liver transplant were excluded. Among 36 patients, 24 (67%) were steroid group and remaining 12 (33%) were non-steroid group. Male-to-female ratio was 1.43 and median age was 44.5 years old (range: 18-62). Bilateral lung transplantation was performed in 14 cases. Most common cause for Lung transplantation was ILD (41%), followed by ARDS due to toxic material (humidifier cleaning solution), pneumonia, and near-drowning. Rare causes were BO after HSCT and pulmonary hypertension. Median APACHE II score at ICU admission was 17.5 (median 10-41). During median follow-up of 32 months, there were 7 mortalities. There were no differences in sex, age, type of transplant, and cause of transplant between steroid group and non-steroid group, while there were tendency of increased APACHE II score in steroid group compared to non-steroid group (15.0 vs 5.5, p=0.054). Post-transplant ICU stay and postoperative hospital stay were longer in steroid group compared to non-steroid group (18.5 vs 10.0 p=0.026, 83.0 vs 46.8 p=0.009, respectively). While infection-related mortality was higher in steroid group (7 vs 0%, p=0.041), there was no difference in overall mortality (p=0.104).

CONCLUSIONS: This study showed that there was no difference between steroid group and non-steroid group in overall mortality. But in steroid group, post-transplant ICU stay and postoperative hospital stay was significantly longer.

CLINICAL IMPLICATIONS: Though difference in overall mortality was not significant, it showed in steroid group, postoperative hospital stay and ICU stay were longer and more infection-related mortality occured. We might need to cease steroids use in lung transplatation candidates, if possible.

DISCLOSURE: The following authors have nothing to disclose: Bo Young Lee, Tae Sun Shim, Kyung-Wook Jo, Sang-bum Hong

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