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.
authors.affiliation: Division of Pulmonary Medicine, IRCCS Policlinico S. Matteo, Pavia, Italy. vitulop@smatteo.pv.it
authors.forename: Patrizio
authors.initials: P
authors.lastname: Vitulo
authors.forename: Tiberio
authors.initials: T
authors.lastname: Oggionni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cascina
authors.forename: Eloisa
authors.initials: E
authors.lastname: Arbustini
authors.forename: Andrea M
authors.initials: AM
authors.lastname: D'Armini
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Federica
authors.initials: F
authors.lastname: Meloni
authors.forename: Albino
authors.initials: A
authors.lastname: Rossi
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
mesh_terms: D000208:Acute Disease; D000328:Adult; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006084:Graft Rejection / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000627:therapeutic use*; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus