1. International experience with conversion from cyclosporine to tacrolimus for acute and chronic lung allograft rejection.
- Author
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Sarahrudi K, Estenne M, Corris P, Niedermayer J, Knoop C, Glanville A, Chaparro C, Verleden G, Gerbase MW, Venuta F, Böttcher H, Aubert JD, Levvey B, Reichenspurner H, Auterith A, and Klepetko W
- Subjects
- Acute Disease, Adult, Australia epidemiology, Azathioprine therapeutic use, Bronchiolitis Obliterans drug therapy, Bronchiolitis Obliterans etiology, Canada epidemiology, Chronic Disease, Drug Therapy, Combination, Europe epidemiology, Female, Follow-Up Studies, Forced Expiratory Volume drug effects, Graft Rejection etiology, Humans, Hypertension, Pulmonary surgery, Incidence, Kidney drug effects, Male, Middle Aged, Postoperative Complications drug therapy, Postoperative Complications etiology, Pulmonary Disease, Chronic Obstructive surgery, Pulmonary Fibrosis surgery, Retrospective Studies, Time Factors, Treatment Outcome, Cyclosporine therapeutic use, Graft Rejection drug therapy, Immunosuppressive Agents therapeutic use, Lung Transplantation immunology, Tacrolimus therapeutic use
- Abstract
Objective: A retrospective study involving 13 institutions was performed to assess the efficacy of conversion from cyclosporine (INN: ciclosporin) to tacrolimus., Methods: Data from 244 patients were analyzed. Indications for conversion were recurrent-ongoing rejection (n = 110) and stage 1 to 3 bronchiolitis obliterans syndrome (n = 134)., Results: The incidence of acute rejection decreased significantly within 3 months after versus before the switch from cyclosporine to tacrolimus (P <.01). For patients with recurrent-ongoing rejection, the forced expiratory volume in 1 second decreased by 1.96% of predicted value per month (P =.08 vs zero slope) before and increased by 0.34% of predicted value per month (P =.32 vs zero slope) after conversion (P <.06). For patients with stage 1 to 3 bronchiolitis obliterans syndrome, a significant reduction of rejection episodes was observed (P <.01). In single transplant recipients a decrease of the forced expiratory volume in 1 second averaged 2.25% of predicted value per month (P <.01 vs zero slope) before and 0.29% of predicted value per month after conversion. Corresponding values for bilateral transplant recipients were 3.7% of predicted value per month (P <.01 vs zero slope) and 0.9% of predicted value per month (P = 0.04 vs zero slope), respectively. No significant difference in the incidence of infections within 3 months before and after conversion was observed., Conclusions: Conversion from cyclosporine to tacrolimus after lung transplantation is associated with reversal of recurrent-ongoing rejection. Conversion for bronchiolitis obliterans syndrome allows short-term stabilization of lung function in most patients.
- Published
- 2004
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