Efficacy of tacrolimus rescue therapy in refractory acute rejection after lung transplantation

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Abstract

Background: Encouraging results in transplantation of other solid organs led to investigation of the use of tacrolimus in lung transplantation as a salvage immunosuppressant in persistent acute rejection. Methods:The incidence and severity of acute rejection and the number of steroid pulses were analyzed in 20 lung recipients who were converted from a cyclosporine- to a tacrolimus-based immunosuppressive regimen because of refractory biopsy-proven acute rejection. Results:Tacrolimus was started 12.0 ± 13.0 months after transplantation, and the mean follow-up was 25.0 ± 13.7 months. After shifting to tacrolimus, a significant decline was observed in both the number of acute rejections per patient (3.0 ± 1.56 to 0.85 ± 1.14, p <0.0001), and the incidence of acute rejection per 100 patient-days (1.52 ± 0.99 to 0.14 ± 0.21, p <0.0001). Furthermore, the average histologic grade of rejection decreased from 1.9 ± 0.8 to 0.4 ± 0.5 (p <0.0001). Methylprednisolone pulses similarly decreased from 1.9 ± 1.3/patient to 0.3 ± 0.7/patient (p <0.0001). During cyclosporine immunosuppression, the mean forced expiratory volume in 1 second decreased to 84.4% ± 13.3% of individual best value. The average lung function parameters were stable 3 months after the change of medication, and then began to improve. After an average follow-up of 36.5 ± 19.2 months, 2 patients have developed bronchiolitis obliterans syndrome (one has Stage 1 and one has Stage 3).Conclusions:Conversion to a tacrolimus-based immunosuppressive regimen for refractory acute lung rejection is associated with reduced incidence and severity of acute rejection episodes, steroid sparing, and stabilization or improvement of pulmonary function.

Original languageEnglish
Pages (from-to)435-439
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume21
Issue number4
DOIs
Publication statusPublished - 2002

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Lung Transplantation
Tacrolimus
Immunosuppressive Agents
Lung
Cyclosporine
Incidence
Transplantation
Steroids
Bronchiolitis Obliterans
Therapeutics
Methylprednisolone
Forced Expiratory Volume
Immunosuppression
Biopsy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

@article{131b5222ee0d4288be69b56861cdbe3b,
title = "Efficacy of tacrolimus rescue therapy in refractory acute rejection after lung transplantation",
abstract = "Background: Encouraging results in transplantation of other solid organs led to investigation of the use of tacrolimus in lung transplantation as a salvage immunosuppressant in persistent acute rejection. Methods:The incidence and severity of acute rejection and the number of steroid pulses were analyzed in 20 lung recipients who were converted from a cyclosporine- to a tacrolimus-based immunosuppressive regimen because of refractory biopsy-proven acute rejection. Results:Tacrolimus was started 12.0 ± 13.0 months after transplantation, and the mean follow-up was 25.0 ± 13.7 months. After shifting to tacrolimus, a significant decline was observed in both the number of acute rejections per patient (3.0 ± 1.56 to 0.85 ± 1.14, p <0.0001), and the incidence of acute rejection per 100 patient-days (1.52 ± 0.99 to 0.14 ± 0.21, p <0.0001). Furthermore, the average histologic grade of rejection decreased from 1.9 ± 0.8 to 0.4 ± 0.5 (p <0.0001). Methylprednisolone pulses similarly decreased from 1.9 ± 1.3/patient to 0.3 ± 0.7/patient (p <0.0001). During cyclosporine immunosuppression, the mean forced expiratory volume in 1 second decreased to 84.4{\%} ± 13.3{\%} of individual best value. The average lung function parameters were stable 3 months after the change of medication, and then began to improve. After an average follow-up of 36.5 ± 19.2 months, 2 patients have developed bronchiolitis obliterans syndrome (one has Stage 1 and one has Stage 3).Conclusions:Conversion to a tacrolimus-based immunosuppressive regimen for refractory acute lung rejection is associated with reduced incidence and severity of acute rejection episodes, steroid sparing, and stabilization or improvement of pulmonary function.",
author = "Patrizio Vitulo and Tiberio Oggionni and Alessandro Cascina and Eloisa Arbustini and D'Armini, {Andrea M.} and Mauro Rinaldi and Federica Meloni and Albino Rossi and Mario Vigan{\`o}",
year = "2002",
doi = "10.1016/S1053-2498(01)00379-5",
language = "English",
volume = "21",
pages = "435--439",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
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T1 - Efficacy of tacrolimus rescue therapy in refractory acute rejection after lung transplantation

AU - Vitulo, Patrizio

AU - Oggionni, Tiberio

AU - Cascina, Alessandro

AU - Arbustini, Eloisa

AU - D'Armini, Andrea M.

AU - Rinaldi, Mauro

AU - Meloni, Federica

AU - Rossi, Albino

AU - Viganò, Mario

PY - 2002

Y1 - 2002

N2 - Background: Encouraging results in transplantation of other solid organs led to investigation of the use of tacrolimus in lung transplantation as a salvage immunosuppressant in persistent acute rejection. Methods:The incidence and severity of acute rejection and the number of steroid pulses were analyzed in 20 lung recipients who were converted from a cyclosporine- to a tacrolimus-based immunosuppressive regimen because of refractory biopsy-proven acute rejection. Results:Tacrolimus was started 12.0 ± 13.0 months after transplantation, and the mean follow-up was 25.0 ± 13.7 months. After shifting to tacrolimus, a significant decline was observed in both the number of acute rejections per patient (3.0 ± 1.56 to 0.85 ± 1.14, p <0.0001), and the incidence of acute rejection per 100 patient-days (1.52 ± 0.99 to 0.14 ± 0.21, p <0.0001). Furthermore, the average histologic grade of rejection decreased from 1.9 ± 0.8 to 0.4 ± 0.5 (p <0.0001). Methylprednisolone pulses similarly decreased from 1.9 ± 1.3/patient to 0.3 ± 0.7/patient (p <0.0001). During cyclosporine immunosuppression, the mean forced expiratory volume in 1 second decreased to 84.4% ± 13.3% of individual best value. The average lung function parameters were stable 3 months after the change of medication, and then began to improve. After an average follow-up of 36.5 ± 19.2 months, 2 patients have developed bronchiolitis obliterans syndrome (one has Stage 1 and one has Stage 3).Conclusions:Conversion to a tacrolimus-based immunosuppressive regimen for refractory acute lung rejection is associated with reduced incidence and severity of acute rejection episodes, steroid sparing, and stabilization or improvement of pulmonary function.

AB - Background: Encouraging results in transplantation of other solid organs led to investigation of the use of tacrolimus in lung transplantation as a salvage immunosuppressant in persistent acute rejection. Methods:The incidence and severity of acute rejection and the number of steroid pulses were analyzed in 20 lung recipients who were converted from a cyclosporine- to a tacrolimus-based immunosuppressive regimen because of refractory biopsy-proven acute rejection. Results:Tacrolimus was started 12.0 ± 13.0 months after transplantation, and the mean follow-up was 25.0 ± 13.7 months. After shifting to tacrolimus, a significant decline was observed in both the number of acute rejections per patient (3.0 ± 1.56 to 0.85 ± 1.14, p <0.0001), and the incidence of acute rejection per 100 patient-days (1.52 ± 0.99 to 0.14 ± 0.21, p <0.0001). Furthermore, the average histologic grade of rejection decreased from 1.9 ± 0.8 to 0.4 ± 0.5 (p <0.0001). Methylprednisolone pulses similarly decreased from 1.9 ± 1.3/patient to 0.3 ± 0.7/patient (p <0.0001). During cyclosporine immunosuppression, the mean forced expiratory volume in 1 second decreased to 84.4% ± 13.3% of individual best value. The average lung function parameters were stable 3 months after the change of medication, and then began to improve. After an average follow-up of 36.5 ± 19.2 months, 2 patients have developed bronchiolitis obliterans syndrome (one has Stage 1 and one has Stage 3).Conclusions:Conversion to a tacrolimus-based immunosuppressive regimen for refractory acute lung rejection is associated with reduced incidence and severity of acute rejection episodes, steroid sparing, and stabilization or improvement of pulmonary function.

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U2 - 10.1016/S1053-2498(01)00379-5

DO - 10.1016/S1053-2498(01)00379-5

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EP - 439

JO - Journal of Heart and Lung Transplantation

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