PURPOSE: Steroids are often used as maintenance immunosuppression and in pulse doses to treat confirmed or suspected rejection following lung transplantation. Traditionally, it has been thought that steroids impede wound healing. This study tests the hypothesis that pulse dose steroids are associated with higher rates of wound dehiscence (WD) following lung transplantation. METHODS: This was a retrospective chart review of 486 patients undergoing lung transplant during 2012-2018 at our institution. Patients were divided into two cohorts: those who did and did not receive pulse dose steroids within 60 days of transplant. The primary outcome was a WD requiring debridement within 90 days of the index operation. A Kaplan-Meier plot and log rank test were used to compare the time to WD between the cohorts. A multivariable Cox model was developed to assess the effect of pulse dose steroids and other selected variables on time to dehiscence. Logistic regression was performed to assess for a dose-response effect on WD. RESULTS: A total of 52 (11%) patients had a WD within 90 days. The median time to WD was 44 days for the overall cohort. There was no association between WD and pulse dose steroids on bivariate analysis (11% pulse vs 10% no pulse; p=.885). On Kaplan Meier analysis, there was no difference in time to WD between the pulse and no pulse dose cohorts (p=.868). On multivariable analysis, none of the following were predictors of WD: pulse dose steroids, age, albumin, HgbA1c, intra-operative transfusion, or CPB; although CPB trended toward significance (HR 1.85, p=.059). No dose-response effect was observed. CONCLUSION: Pulse dose steroids are used in the treatment of confirmed or suspected acute rejection. Contrary to our hypothesis, steroid pulses are not associated with increased rates of WD following lung transplantation.
|Original language||English (US)|
|Journal||The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation|
|State||Published - Apr 1 2020|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine