Steroid Withdrawal in Lung Transplant Recipients

Borro, J.M.; Solé, Amparó; Torre, Mercedes de la; Pastor, A.; Tarazona, V.

doi:10.1016/j.transproceed.2005.09.190

Cited by 29 publications

(15 citation statements)

References 6 publications

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“…At the present time, there is no recommendation with regard to weaning of corticosteroid after LT for pediatric recipients. A few studies suggested that withdrawing corticosteroid soon after LT for adult recipients could reduce side-effects [5][6][7]. Shitrit et al [5] attempted withdrawal of corticosteroid on 35 patients who underwent heart-lung or lung transplant.…”

Section: Discussionmentioning

confidence: 99%

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Substitution of corticosteroid with everolimus after lung transplantation: a pediatric case report

et al. 2010

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We report the case of a 12 year-old lung transplant recipient, in whom compressive epidural lipomatosis secondary to corticosteroid prompted us to replace prednisone with everolimus. Discontinuing corticosteroid treatment after lung transplantation is associated with a risk of graft rejection despite concomitant immunosuppressive therapy with tacrolimus and mycophenolate mofetil. During a follow-up of 18 months with everolimus instead of prednisone, we did not observe graft rejection. In parallel, all symptoms related to epidural compression disappeared within a month.

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Section: Discussionmentioning

confidence: 99%

“…In this study, patients treated without steroids had no clinical benefit. Borro et al [6] selected 34 stable lung transplant recipients to be systematically tapered off steroids. The majority of patients were maintained on cyclosporin and azathioprine.…”

Section: Discussionmentioning

confidence: 99%

Substitution of corticosteroid with everolimus after lung transplantation: a pediatric case report

et al. 2010

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“…Beobachtungen an Patienten mit langfristig stabilem Verlauf zeigen, dass eine steroidfreie Immunsuppression auch nach LTX möglich ist, ohne den Transplantationserfolg zu gefährden. Darüber hinaus stellen sich positive Effekte für Begleiterkrankungen wie Diabetes mellitus, arterielle Hypertonie und Hypercholesterinämie auch bei Fortführung der übrigen Immunsuppressiva ein [52,53].…”

Section: Kortikosteroideunclassified

Immunsuppression und Infektionsprophylaxe nach Lungentransplantation

Neurohr

Behr²

2010

Pneumologie

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!Lung transplantation (LTX) is an established therapeutic option for end-stage lung diseases. The main reasons for limited long-term survival rates are infections and bronchiolitis obliterans syndrome (BOS). An optimal immunosuppressive regimen is of critical importance for the prevention of both complications. Induction therapy is used in approximately 60 % of recipients. However, there are no controlled trials demonstrating a significant long-term survival benefit. The vast majority of patients receive a triple maintenance immunosuppressive therapy consisting of a calcineurin-inhibitor, a cell cycle inhibitor and corticosteroids. So far, no specific immunosuppressive drug combination has proven superiority regarding long-term survival rates. The potential benefits of the proliferation signal inhibitors sirolimus and everolimus remain to be elucidated. Therapeutic options for BOS encompass a switch in maintenance therapy, renewed induction therapy, aerolised cyclosporine, azithromycine, extracorporeal photopheresis and total lymphoid irradiation. Infection prophylaxis after LTX plays a pivotal role to guard against acute complications and for the prevention of BOS. In particular, prophylaxis for pneumocystis and cytomegalovirus disease is very effective. Moreover, colonisation with Pseudomonas aeruginosa and Aspergillus spp. was identified as risk factor for BOS. Consequently, in most transplant centres prophylactic and pre-emptive therapeutic approaches are applied in varying degrees.Neurohr C, Behr J. Immunsuppression und Infektionsprophylaxe nach Lungentransplantation Pneumologie 2011; 65: 94 -102

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“…Because individual glucocorticoid sensitivity is known to be influenced by various factors [6][7][8][9][10][11], monitoring the therapeutic levels of glucocorticoids is not a realistic option. Nonetheless, recipients of LT generally require glucocorticoids over their lifetimes, although the successful withdrawal of glucocorticoids after LT has previously been reported in a few patients after LT [12,13]. Given the difficulty in monitoring the therapeutic levels of glucocorticoids, the routinely used maintenance dose of glucocorticoids might be insufficient for patients with poor glucocorticoid sensitivity, which may influence the risk of the onset of CLAD after LT.…”

Section: Introductionmentioning

confidence: 99%