Successful steroid withdrawal in lung transplant recipients: Result of a pilot study

Objective: Corticosteroids play a key role in immunosuppression after transplantation. However, because chronic steroid treatment may cause significant morbidity and mortality, steroid-free immunosuppression remains a desirable goal. To the best of our knowledge, there are no reports on successful steroid withdrawal (SW) in lung transplant recipients. Methods: The study group included 35 patients who underwent heart-lung, double-lung or single-lung transplantation. Criteria for initiation of SW were stable pulmonary function tests and absence of clinical or bronchoscopic evidence of acute or chronic rejection in the last 6 months. Pulmonary function, blood pressure and metabolic parameters were compared between the patients who underwent SW and those who did not. Results: Eight patients (23%) underwent SW. Median follow-up was 19 months (range 11-23 months). Compared to the non-withdrawal group, the withdrawal group was older (60±6±vs. 52±13 years, P = 0.01, r = 0.49), had higher rates of emphysema (88% vs. 18%, P = 0.01) and use of a cyclosporine-based regimen (62% vs. 26%, P = 0.0001), and had longer time from transplantation to the withdrawal attempt (70±13 vs. 29±26 months, P = 0.0002). The SW group showed no adverse effects in graft function and no deterioration on pulmonary function tests. SW had a beneficial metabolic effect, with a decrease in mean cholesterol level from 229±45 to 194±25 mg/dl (P = 0.02) and no significant change in weight, systolic blood pressure or glucose level. In the non-withdrawal group, mean cholesterol levels increased from 175±34 to 209±57 mg/dl (P = 0.0005), weight increased from 72±15 to 80±14 kg (P = 0.0001), and systolic blood pressure increased from 125±15 to 139±16 mmHg (P = 0.001); glucose levels did not change. There was a significant correlation between total cholesterol level and weight in both groups (P = 0.0006, r = -0.56 and P = 0.01, r = -0.46, respectively). Conclusions: Late SW is safe in stable patients after lung transplantation. There was no evidence of rejection or a deterioration in pulmonary function. Lipid profile improvement and blood pressure stabilization accompanied the termination of steroid therapy.