Progress in TransplantationLung transplantationSafety and Efficacy of Steroid Pulse Therapy for Acute Loss of FEV1 in Lung Transplant Recipients After Exclusion of Acute Cellular Rejection
Section snippets
Patient Population and Standard of Care
We retrospectively included consecutive patients who had a LTx between 2015 and 2018 and who experienced loss of FEV1 from baseline of more than 10%.
Criteria for inclusion were absence of all causes that could explain loss of FEV1, including acute cellular rejection (A ≥ 1 according to ISHLT), humoral rejection (C4d positivity or donor-specific human leukocyte antigen antibodies), infections, bronchial stenosis and other specific causes such as persistent acute rejection, anastomotic stricture,
Patient Cohort
A total of 33 patients (51.5% male) were included in this study, 87.9% of whom had a bilateral LTx (BLTx) (Table 1). Mean age ± SD at the time of loss of FEV1 was 50.5 ± 12.5 years.
The mean time ± SD of observation after LTx with available pulmonary function data until loss of FEV1 and treatment with prednisolone pulse was 46.5 ± 35.7 months (range, 4-129), with a total mean follow-up time ± SD after pulse therapy of 176.4 ± 38.9 days. The mean number of available lung function tests ± SD
Discussion
The absence of an effective treatment for decline of lung function and BOS still limits survival in LTx recipients. Treatment with azithromycin, switching cyclosporine to tacrolimus, and managing gastroesophageal reflux have shown positive effects on lung function [[3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]]. Retransplantation should be considered in select patients with end-stage BOS [[15], [16], [17]].
We clearly recognize the limitations of our study, given the
Conclusions
Given the lack of data and limited therapeutic options to treat loss of FEV1 and CLAD in LTx recipients, our study adds important data to the field. We show that a subgroup of patients has a sustained benefit from steroid pulse therapy, while this approach may be associated with severe complications. Patients with BAL eosinophilia are more likely to respond. Steroid pulse therapy has a higher value for this subgroup. Further investigations are necessary to guide the treatment of patients after
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Cited by (2)
Polyomavirus exerts detrimental effects on renal function in patients after lung transplantation
2021, Journal of Clinical VirologyCitation Excerpt :In case of clinical suspicion for acute rejection or deterioration of lung function, immunosuppression was augmented. Pneumocystis jirovecii pneumonia prophylaxis (sulfamethoxazole/trimethoprim) was maintained throughout the study period [18, 20]. According to pre-transplant serologic assessment, patients with high or intermediate risk for CMV-reactivation are treated with valganciclovir in a prophylactic dose (900 mg once daily and dose adjusted to kidney function, respectively) for 6–9 months [21].
Surveillance Bronchoscopy for the Care of Lung Transplant Recipients: A Retrospective Single Center Analysis
2021, Transplantation ProceedingsCitation Excerpt :This finding is in line with previous reports from other groups that found increased eosinophils in lung transplant recipients with ACR or worse prognosis [25–27]. A recent publication reported that lung transplant recipients with lung function deterioration but without histologically proven rejection benefit from steroid pulse therapy when eosinophils in BAL are elevated [28]. In the context of the results presented in this study, one might speculate that sampling errors may have contributed to the missing histological proof of a rejection episode.
The first 2 authors contributed equally to this work.