International experience with conversion from cyclosporine to tacrolimus for acute and chronic lung allograft rejection.
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.
Sarahrudi
Kambiz
K
Department of Cardithoracic Surgery, University of Vienna, Austria.
Estenne
Marc
M
Corris
Paul
P
Niedermayer
Jost
J
Knoop
Christiane
C
Glanville
Allan
A
Chaparro
Cecilia
C
Verleden
Geert
G
Gerbase
Margaret W
MW
Venuta
Federico
F
Böttcher
Heidi
H
Aubert
John D
JD
Levvey
Bronwyn
B
Reichenspurner
Hermann
H
Auterith
Alexandra
A
Klepetko
Walter
W
D000208:Acute Disease; D000328:Adult; D001315:Australia / Q000453:epidemiology; D001379:Azathioprine / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000188:drug therapy / Q000209:etiology; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007668:Kidney / Q000187:drug effects; D016040:Lung Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000601:surgery; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D016559:Tacrolimus