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

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 tow-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. (C) 2009 Elsevier Ltd. All rights reserved.