Optimization of the Immunosuppressive Protocol After Lung Transplantation1

Abstract

Tac-based immunosuppressive therapy results in a lower rate of acute rejection after pulmonary transplantation, with similar infection rates and a slightly higher incidence of new onset diabetes mellitus compared with CsA-based therapy.

Immunosuppressive therapy after human lung transplantation

“…The Tac, MMF and steroids9 group could not yet be evaluated for BOS and survival because of a limited followup. The significance of these interesting findings is, however, weakened by the small number of patients and the retrospective design of the study [76].…”

Erratic tacrolimus exposure, assessed using the standard deviation of trough blood levels, predicts chronic lung allograft dysfunction and survival

“…The median number of tacrolimus measurements per patient for the 0-6, 6-12 and 12-24 month periods were 15 (IQR 8 -24), 11 (7-17, range 2-30 measurements) and 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) respectively. There was a positive correlation between the number of tacrolimus measurements and trough level SD (r = 0.489 p<0.001, Figure 3) but not with the mean (p=0.698).…”

“…While the mean drug level required to prevent rejection has been well studied, little attention has been paid to the effect of erratic tacrolimus exposure, but with a satisfactory mean, in lung transplantation (15,(17)(18)(19)(20)(21)(22). There are good reasons to believe that erratic exposure may be just as deleterious as sub-therapeutic tacrolimus exposure, but this possibility has been little explored.…”

Overview of tacrolimus-based immunosuppression after heart or lung transplantation

“…[55][56][57][58][59][60][61] In 1 prospective, open-label, single-center trial, 133 single and bilateral lung recipients were randomized to receive either tacrolimus (n ϭ 66) or cyclosporine (n ϭ 67) together with azathioprine and corticosteroids. 55 One-and 2-year survival rates were similar (Table 2).…”