Airway anastomosis complications in de novo lung transplantation with sirolimus-based immunosuppression.
A prospective, pilot trial was started to evaluate the effect of a sirolimus-based immunosuppressive regimen on acute and chronic rejection in de novo lung transplant patients. Primary lung transplant (LTx) recipients received a sirolimus- and tacrolimus-based immunosuppressive therapy immediately after transplantation. Both immunosuppressants were administered with trough level adjusted, while steroid administration was minimized. Four patients were enrolled (2 single-lung transplants, 1 double-lung transplant, 1 heart-lung transplant) in the study. Mean ischemia time was 387 +/- 92 minutes. Acute rejection (at least Grade A1 ISHLT) was detected in 1 patient. Incidence of infection was 0.6 infection per 100 patient-days (3 Aspergillus infections). Until hospital discharge mean sirolimus trough level was 6.2 +/- 1.2 ng/ml. Depending upon mean sirolimus trough levels of each patient, severe wound-healing complications were seen in 3 patients, resulting in bronchial airway dehiscence in 2 patients with lethal outcome in 1 patient. As a result of these complications, we revised the study design after inclusion of only 4 patients: Sirolimus administration is now started after completion of bronchial wound-healing. Sirolimus-based immunosuppressive therapy administered immediately after lung transplantation seems to be associated with severe wound-healing complications of the bronchial anastomosis.
Groetzner
Jan
J
Department of Cardiac Surgery, Ludwig Maximilians University Hospital Grosshadern, Munich, Germany. jan.groetzner@hch.med.uni-muenchen.de
Kur
Felix
F
Spelsberg
Fritz
F
Behr
Jurgen
J
Frey
Lorenz
L
Bittmann
Iris
I
Vogeser
Michael
M
Ueberfuhr
Peter
P
Meiser
Bruno
B
Hatz
Rudolf
R
Reichart
Bruno
B
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001982:Bronchial Diseases / Q000209:etiology*; D006084:Graft Rejection / Q000517:prevention & control; D016041:Heart-Lung Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage; D014945:Wound Healing / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus