Lung rejectionTime-related changes in pulmonary function after conversion to tacrolimus in bronchiolitis obliterans syndrome
Section snippets
Materials and methods
Two hundred forty-eight patients underwent 253 heart–lung or lung transplants between January 1, 1990 and December 31, 1995 (heart–lung transplant [HLTx] = 75; double-lung transplant [DLTx] = 30; bilateral single-lung transplant [BiSLTx] = 19; single-lung transplant [SLTx] = 129). Ninety-four patients developed BOS. BOS was diagnosed using International Society for Heart and Lung Transplantation (ISHLT) criteria.4 Lung function data before and after conversion to tacrolimus were available for
Results
Thirty-two patients who were converted from cyclosporine to tacrolimus for BOS were included in this study. At the time of diagnosis of BOS, 21 patients were classified as BOS Grade 1a, 3 as BOS Grade 1b, 5 as BOS Grade 2a, 1 as BOS Grade 2b and 2 as BOS Grade 3a.
There were 19 patients in the responder sub-group and 8 in the non-responder group, and 5 patients had insufficient lung function data (due mostly to a lack of spirometric data in the 3 months before conversion to tacrolimus) for
Discussion
This study has defined the range of clinical responses of lung transplant patients to conversion from cyclosporine- to tacrolimus-based immunosuppression after diagnosis of BOS. The majority of patients (n = 19) showed a reduction in the rate of deterioration of lung function. Non-response to conversion to tacrolimus was associated with a poor prognosis as borne out by a trend in the actuarial survival data, although the comparison between responder and non-responder sub-groups did not achieve
Acknowledgements
The authors gratefully acknowledge Jackie Turner, medical statistician, for the contribution to the statistical analyses.
References (32)
- et al.
Heart–lung transplantation for primary pulmonary hypertension
Ann Thorac Surg
(1999) - et al.
Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation
J Thorac Cardiovasc Surg
(1997) - et al.
Bronchiolitis obliterans in recipients of single, double, and heart–lung transplantation
Chest
(1995) - et al.
FK 506 ‘rescue’ immunosuppression for obliterative bronchiolitis after lung transplantation
Chest
(1997) - et al.
Conservation of small-airway function by tacrolimus/cyclosporine conversion in the management of bronchiolitis obliterans following lung transplantation
J Heart Lung Transplant
(2000) - et al.
Adjuvant treatment of refractory lung transplant rejection with extracorporeal photopheresis
J Thorac Cardiovasc Surg
(1999) - et al.
Mycophenolate mofetil for obliterative bronchiolitis syndrome after lung transplantation
Ann Thorac Surg
(1997) - et al.
Efficacy of total lymphoid irradiation for chronic allograft rejection following bilateral lung transplantation
Int J Radiat Oncol Biol Phys
(1998) - et al.
Cytolytic therapy for the bronchiolitis obliterans syndrome complicating lung transplantation
Chest
(1996) - et al.
The registry of the International Society for Heart and Lung Transplantationseventeeth official report—2000
J Heart Lung Transplant
(2000)
Effect of development of antibodies to HLA and cytomegalovirus mismatch on lung transplantation survival and development of bronchiolitis obliterans syndrome
J Thorac Cardiovasc Surg
Efficacy of tacrolimus in the treatment of refractory rejection in heart and lung transplant recipients
J Heart Lung Transplant
Bronchiolitis obliterans syndromeincidence, natural history, prognosis, and risk factors
J Heart Lung Transplant
Actuarial survival of heart–lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis
J Heart Lung Transplant
A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts
J Heart Lung Transplant
Obliterative bronchiolitis after lung and heart-lung transplantationAn analysis of risk factors and management
J Thorac Cardiovasc Surg
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2012, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Few therapies improve outcomes in patients once BOS has developed, and despite advances in the early detection and treatment of acute rejection, the prevalence of BOS has not appreciably changed in recent years.79 Changing the primary immunosuppressive regimen (ie, converting cyclosporine to tacrolimus or azathioprine to mycophenolate mofetil) has been shown in small studies to stabilize the course of BOS.81,82 Extracorporeal photopheresis (ECP) and total lymphoid irradiation (TLI) have been shown to slow the decline in lung function in patients with BOS, although the side effects of TLI may be poorly tolerated.83–86
Tacrolimus Treatment Effectively Inhibits Progression of Obliterative Airway Disease Even at Later Stages of Disease Development
2008, Journal of Heart and Lung TransplantationCitation Excerpt :Together with preliminary data implicating that conversion from CsA-based immunosuppression to tacrolimus-based immunosuppression may halt the advance of bronchiolitis obliterans syndrome,6,7 our study highlights the importance of strong IL-2 inhibition in this disease process and suggests that enhanced suppression of IL-2–mediated immune responses may inhibit early OB.
Bronchiolitis Obliterans Disclaimer: Copyright Note
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