Conservation of small-airway function by tacrolimus/cyclosporine conversion in the management of bronchiolitis obliterans following lung transplantation

Revell, Matthew P.; Lewis, Michael; Llewellyn-Jones, Carol; Wilson, Ian C.; Bonser, Robert S.

doi:10.1016/s1053-2498(00)00206-0

Cited by 25 publications

(18 citation statements)

References 13 publications

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“…If patients are receiving cyclosporine A-based immunosuppression, switching from cyclosporine A to tacrolimus has been reported to slow lung function loss in a number of case series [99][100][101][102][103][104][105][106][107][108]. However, no randomised trials have been performed to support this switch.…”

Section: Converting Cyclosporine To Tacrolimusmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

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Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS.A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations.The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS.The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention. Executive summaryMany lung transplant recipients develop delayed allograft dysfunction that has been traditionally referred to as bronchiolitis obliterans syndrome (BOS), which is thought to be caused by inflammation, destruction and fibrosis of small airways in the lung allograft that leads to obliterative bronchiolitis (OB). Because a definitive diagnosis of OB is difficult to make without a surgical lung biopsy, a decrease in the forced expiratory volume in 1 s (FEV1) has been used as a surrogate marker to identify patients who develop a syndrome of significant and persistent loss of lung allograft function with onset three or more months following transplantation. However, it is now recognised that numerous factors apart from OB can lead to a delayed onset, significant decline in lung function, and these causes of delayed onset graft dysfunction must be carefully excluded when a diagnosis of BOS is made. In general, BOS responds poorly to therapeutic interventions but may stabilise, and some patients may have a significant improvement in FEV1 with certain ther...

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Section: Converting Cyclosporine To Tacrolimusmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

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“…Several small studies have assessed the impact of conversion from Tac to CsA in patients with established BOS [101][102][103][104]. In each study, conversion from CsA to Tac significantly decreased the monthly rate of decline in FEV1 in each BOS group with stabilisation of FEV1 values.…”

Section: Modification Of Maintenance Immune Suppressionmentioning

confidence: 99%

Immunosuppressive therapy after human lung transplantation

Knoop¹,

Haverich²,

Fischer³

2003

Eur Respir J

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numbers of lung transplantation (LTx) were performed with or without induction therapy with antilymphocyte antibodies, monoclonal anti-CD3 antibody or anti-interleukin-2-receptor monoclonal antibodies. It remains to be established if induction therapy after LTx is beneficial or deleterious for long-term graft and patient survival.The vast majority of lung transplant recipients receive a triple-drug maintenance regimen including a calcineurin inhibitor, a cell-cycle inhibitor and steroids. Equal proportions receive cyclosporin A (CsA) and tacrolimus (Tac). There is also a trend to prescribe mycophenolate mofetil (MMF) instead of azathioprine (Aza). Steroid withdrawal is uncommon even 5 yrs after transplantation.The superiority of Tac over CsA as a maintenance agent has not been established to date, and the administration of MMF instead of Aza in combination with CsA and steroids did not improve graft or patient survival in a recent international, prospective, randomised, controlled trial.Shift from cyclosporin A to tacrolimus has emerged as the first treatment step of refractory acute rejection followed by high-dose steroids or antilymphocyte agents, total lymphoid irradiation or photopheresis. The treatment of chronic rejection remains deceptive and includes varied strategies such as modification of the maintenance regimen, addition of inhaled immunosuppressants and/or total lymphoid irradiation and photopheresis. Eur Respir J 2004; 23: 159-171.

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“…To our knowledge, this type of analysis of a treatment intervention in IPF has not been reported previously. There is precedent for this approach in assessing treatment efficacy with other pulmonary maladies such as post-transplant bronchiolitis obliterans syndrome [10, 11]. …”

Section: Discussionmentioning

confidence: 99%

Interferon gamma-1b as Therapy for Idiopathic Pulmonary Fibrosis

Nathan

Barnett²,

Moran³

et al. 2004

Respiration

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Background: The only proven therapeutic option for idiopathic pulmonary fibrosis (IPF) is lung transplantation. It is biologically plausible that interferon gamma-1b (G-IFN) may halt or even reverse the disease process and therefore prove to be an effective medical therapy. We report our results using this medication in a cohort of patients with a wide range of severity of IPF. Objectives: To determine the impact of G-IFN therapy on the progression of disease in patients with IPF. Methods: We performed a retrospective analysis of patients’ pulmonary function tests (PFTs), specifically the forced vital capacity (FVC) and the single breath diffusing capacity for carbon dioxide (DL_CO). Comparisons of these parameters prior to and after the implementation of therapy were made by generating regression slopes by least-squares equations. Results: Twenty-two patients qualified for the analysis. For the FVC, comparison of pre- and post-therapy best-fit regression lines demonstrated a significant difference in favor of G-IFN (p < 0.015). For the DL_CO, a significant difference in favor of gamma interferon therapy was detected in the advanced group (p < 0.03). Seventy percent of the patients showed either stabilization or regression of disease in both their FVCs and their DL_CO. Conclusion: G-IFN appears to be an effective new therapy for patients with IPF. Salutary effects on the rate of change in the FVC and DL_CO were most apparent in patients with advanced disease. With slowing or reversal in loss of lung function, G-IFN may improve longevity and may have utility as a bridge to lung transplantation in those patients who are appropriate candidates.

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Conservation of small-airway function by tacrolimus/cyclosporine conversion in the management of bronchiolitis obliterans following lung transplantation

Cited by 25 publications

References 13 publications

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

Immunosuppressive therapy after human lung transplantation

Interferon gamma-1b as Therapy for Idiopathic Pulmonary Fibrosis

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