title: Aerosolized cyclosporine in lung recipients with refractory chronic rejection.
abstract: This study evaluated aerosolized cyclosporine as rescue therapy for lung transplant recipients with unremitting chronic rejection. Nine patients with histologic active obliterative bronchiolitis and progressively worsening airway obstruction refractory to conventional immune suppression received aerosolized cyclosporine. Improvement in rejection histology was seen in seven of nine patients. We compared the changes in the FVC and FEV1 over time using linear regression analysis in these seven histologic responders and nine historical control patients. During the pretreatment period for both the experimental and control groups, the FVC and FEV1 declined at comparable rates. After aerosolized cyclosporine there was stabilization of pulmonary function, whereas in the controls there was continued decline. Cyclosporine blood levels were less than 50 ng/ml 24 h after an aerosolized dose of 300 mg in five patients receiving oral tacrolimus. Nephrotoxicity, hepatotoxicity, and a greater than expected rate of infection was not observed. This study suggests that aerosolized cyclosporine is safe and may be effective therapy for refractory chronic rejection in lung transplant recipients.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Iacono
authors.forename: R J
authors.initials: RJ
authors.lastname: Keenan
authors.forename: S R
authors.initials: SR
authors.lastname: Duncan
authors.forename: G C
authors.initials: GC
authors.lastname: Smaldone
authors.forename: J H
authors.initials: JH
authors.lastname: Dauber
authors.forename: I L
authors.initials: IL
authors.lastname: Paradis
authors.forename: N P
authors.initials: NP
authors.lastname: Ohori
authors.forename: W F
authors.initials: WF
authors.lastname: Grgurich
authors.forename: G J
authors.initials: GJ
authors.lastname: Burckart
authors.forename: A
authors.initials: A
authors.lastname: Zeevi
authors.forename: E
authors.initials: E
authors.lastname: Delgado
authors.forename: T G
authors.initials: TG
authors.lastname: O'Riordan
authors.forename: M M
authors.initials: MM
authors.lastname: Zendarsky
authors.forename: S A
authors.initials: SA
authors.lastname: Yousem
authors.forename: B P
authors.initials: BP
authors.lastname: Griffith
mesh_terms: D000328:Adult; D000336:Aerosols; D001989:Bronchiolitis Obliterans / Q000188:drug therapy; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D012129:Respiratory Function Tests
chemical_list: D000336:Aerosols; D007166:Immunosuppressive Agents; D016572:Cyclosporine