Chest
Clinical Investigations: Lung TransplantationFK 506 ‘Rescue’ Immunosuppression for Obliterative Bronchiolitis After Lung Transplantation
Section snippets
MATERIALS AND METHODS
In a case series (level V evidence), 10 patients who were between 5.5 and 55 months (27.6±6.7, mean±SEM) post-LT had developed histologically confirmed OB that was deemed “clinically progressive” by sequential spirometric evaluation, despite repeated courses of pulsed-dose methylprednisolone. Patients were enrolled in the study between October 1, 1993, and April 1, 1996. The Fujisawa protocol 93-0-003 for “salvage” in CR had been approved by our Institutional Review Board and informed consent
RESULTS
Overall prevalence of OB in our program is currently 31%; (11/36 patients). As defined by the International Society for Heart and Lung Transplantation criteria, patients were categorized as having OB stages Ib (n=2), IIb (n=4), and IIIb (n=4) upon entry to the study protocol between October 1, 1993, and April 1, 1996. The study commenced during Fujisawa protocol 93-0-003 for chronic or refractory acute allograft rejection. At that time, only recipients with histologically confirmed OB were
DISCUSSION
Long-term survival after LT has been limited by the development of OB with a variously reported incidence between 10 and 70%;.3,9, 10 Although augmented immunosuppression may result in transient stabilization of allograft function, infectious complications may be increased.5 Data derived from orthotopic liver transplantation have suggested a decreased incidence as well as potential stabilization of CR with FK 506 immunosuppression.6, 7 The vanishing bile duct syndrome as a manifestation of CR
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2012, ChestCitation Excerpt :It has also been used to treat graft-vs-host disease, rheumatologic disorders (lupus erythematosus, rheumatoid arthritis, scleroderma, polymyositis), inflammatory bowel disease, various skin conditions other than atopic dermatitis, and uveitis. Table 13 summarizes the 16 clinical trials reporting on the use of tacrolimus for various lung diseases.151,152,179–192 The FDA has issued a black box warning for increased susceptibility to infection and the possible development of lymphoma.193
Bronchiolitis Obliterans Disclaimer: Copyright Note
2008, Pediatric Respiratory MedicineBronchiolitis Obliterans
2008, Pediatric Respiratory MedicineConversion From Cyclosporine to Tacrolimus Stabilizes the Course of Lung Function in Lung Transplant Recipients With Bronchiolitis Obliterans Syndrome
2007, Transplantation ProceedingsCitation Excerpt :Already in 1997, a small study of 15 patients by Kesten et al3 found that conversion from a CsA-based regimen to a tacrolimus-based regimen was associated with a decrease in the rate of decrease of lung function in patients with BOS, although stabilization of lung function was not achieved in their study. In the same year, Ross et al4 also, in a very short series of 10 patients, did not find a significant spirometric improvement, but noted that no further decrease in lung function occurred after conversion and that patients with less severe stages of BOS were the ones who benefited most from conversion. In 2000, however, another small retrospective study in 10 patients found a significant reduction in the slope of the FEV1-time curve after conversion from CsA to tacrolimus.5
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