Indicators for steroid response in biopsy proven acute graft rejection after lung transplantation

Fuehner, T.; Simon, A.; Dierich, M.; DeWall, C.; Laenger, F.; Pletz, M.W.; Welte, T.; Gottlieb, J.

doi:10.1016/j.rmed.2009.03.013

« Previous Next »Respiratory Medicine
Volume 103, Issue 8 , Pages 1114-1121, August 2009

Indicators for steroid response in biopsy proven acute graft rejection after lung transplantation

T. Fuehner
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Corresponding author. Tel.: +49 5115328505.
A. Simon
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Germany
M. Dierich
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
C. DeWall
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
F. Laenger
- Institute of Pathology, Hannover Medical School, Germany
M.W. Pletz
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
T. Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
J. Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany

Received 23 January 2009; accepted 6 March 2009. published online 27 April 2009.

Summary

Objective

Acute rejection (AR) after lung transplantation (LTx) requires prompt intervention. Most episodes respond to steroid pulse therapy. The aim of this study was to evaluate clinical indicators for non-response to steroid treatment in biopsy proven AR after the early postoperative period.

Methods

We prospectively analysed 85 patients more than 6 months after LTx with symptomatic biopsy proven AR (≥grade A1) from Jan. 2005 until Nov. 2007 in a single centre. In 47 patients, AR was steroid-sensitive (group 1), 38 patients did not respond to steroid pulse therapy (group 2). All AR episodes were associated with clinical symptoms. Fifty-seven (67%) were low-grade rejections (ISHLT A1).

Results

Independent clinical predictors for steroid response vs. non-steroid response in biopsy proven AR were “days after transplantation” (p=0.01, adjusted hazard ratio (HR) 1.2), “decline in home spirometry slope” (p=0.03, HR 0.97), “adherence to home spirometry” (p=0.05, HR 0.98) and “serum CRP” (p=0.02, HR 0.87). Eight patients (21%) of group 2 developed BOS during the following 6 months.

Conclusions

Early detection of deterioration in graft function seems to be crucial for effective treatment of AR. Home spirometry seems to be useful in detecting early changes in graft function and surveillance protocols could be potentially helpful in predicting patients likely to demonstrate a steroid response.

Keywords: Lung transplantation, Acute cellular rejection, Clinical indicators, Bronchoscopy, Bronchiolitis obliterans syndrome