title: Successful use in lung transplantation of an immunosuppressive regimen aimed at reducing target blood levels of sirolimus and tacrolimus.
abstract: BACKGROUND
  The primary aim of this study was to assess the safety and efficacy in lung transplantation of an immunosuppressive regimen aimed at achieving sirolimus and tacrolimus concentrations of 6 to 10 microg/ml and 5 to 7 ng/ml, respectively.
  
  
  METHODS
  We retrospectively identified 49 lung transplant recipients who were converted to an immunosuppressive regimen consisting of tacrolimus, sirolimus, and prednisone. Data collected included demographic information, laboratory work, episodes of rejection, bronchiolitis obliterans syndrome (BOS) grade, and adverse effects.
  
  
  RESULTS
  The most common reason for conversion to a sirolimus and tacrolimus regimen was BOS. The most common adverse effects were increased triglycerides (10%), leukopenia (8%), and skin rash (6%). Four patients (8%) experienced acute allograft rejection during the study period. We followed BOS grade for 1 year in 23 patients. Of these, BOS grade improved in 8, 13 patients remained unchanged, and 2 worsened. Eleven patients (22%) discontinued sirolimus because of adverse events.
  
  
  CONCLUSIONS
  An immunosuppressive regimen consisting of sirolimus and tacrolimus that aims to keep the trough drug concentrations at 6 to 10 microg/ml and 5 to 7 ng/ml, respectively, provides effective lung allograft protection while maintaining an acceptable side-effect profile. The use of this immunosuppressive combination may have a benefit with regard to BOS.
authors.affiliation: Division of Pulmonary and Critical Care, Loyola University Medical Center, Maywood, Illinois 60153, USA. j.villan@lumc.edu
authors.forename: Jaime
authors.initials: J
authors.lastname: Villanueva
authors.forename: Ali
authors.initials: A
authors.lastname: Boukhamseen
authors.forename: Sangeeta M
authors.initials: SM
authors.lastname: Bhorade
mesh_terms: D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000097:blood / Q000139:chemically induced; D001999:Bronchoscopy; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000097:blood* / Q000150:complications / Q000517:prevention & control; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics*; D008055:Lipids / Q000097:blood; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D020123:Sirolimus / Q000009:adverse effects / Q000493:pharmacokinetics*; D016559:Tacrolimus / Q000009:adverse effects / Q000493:pharmacokinetics*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008055:Lipids; D020123:Sirolimus; D016559:Tacrolimus