title: Airway anastomosis complications in de novo lung transplantation with sirolimus-based immunosuppression.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, Ludwig Maximilians University Hospital Grosshadern, Munich, Germany. jan.groetzner@hch.med.uni-muenchen.de
authors.forename: Jan
authors.initials: J
authors.lastname: Groetzner
authors.forename: Felix
authors.initials: F
authors.lastname: Kur
authors.forename: Fritz
authors.initials: F
authors.lastname: Spelsberg
authors.forename: Jurgen
authors.initials: J
authors.lastname: Behr
authors.forename: Lorenz
authors.initials: L
authors.lastname: Frey
authors.forename: Iris
authors.initials: I
authors.lastname: Bittmann
authors.forename: Michael
authors.initials: M
authors.lastname: Vogeser
authors.forename: Peter
authors.initials: P
authors.lastname: Ueberfuhr
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hatz
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus