title: Mycophenolate mofetil reduces alveolar inflammation, acute rejection and graft loss due to bronchiolitis obliterans syndrome after lung transplantation.
abstract: BACKGROUND
  Bronchiolitis obliterans syndrome (BOS) is still the main complication after lung transplantation. Besides other improvements in post-operative management, newer immunosuppressive regimens might decrease the devastating sequelae of this complication.
  
  
  METHODS
  We compared the prospectively collected data of lung transplant recipients treated either with azathioprine (AZA; n = 48) or mycophenolate mofetil (MMF; n = 108), who underwent regular monthly surveillance bronchoscopies for at least 6 post-operative months.
  
  
  RESULTS
  Patients on MMF had significantly fewer acute (P < 0.001) and recurrent (P < 0.001), as well as less severe rejection episodes (P = 0.01). In addition, MMF significantly reduced the number of alveolar lymphocytes, eosinophils and neutrophils (P < 0.001), and decreased the hemosiderin score reflecting non-specific alveolar-capillary damage (P < 0.001). Although there was no change in the three stages of BOS, there was a trend towards improved survival (P = 0.062) and a significant decrease in graft loss due to BOS (P = 0.049) in patients receiving MMF.
  
  
  CONCLUSIONS
  Immunosuppression with MMF significantly decreased the incidence, severity and recurrence of acute rejection episodes in lung transplant recipients. Parameters of alveolar inflammation and alveolar-capillary damage were also decreased. As a potential consequence, MMF significantly reduced graft loss due to BOS and tended to improve overall survival in these patients.
authors.affiliation: Zurich Lung Transplant Program, University Hospital, Zurich, Switzerland. rudolf.speich@usz.ch
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.forename: Silvia
authors.initials: S
authors.lastname: Schneider
authors.forename: Markus
authors.initials: M
authors.lastname: Hofer
authors.forename: Sarosh
authors.initials: S
authors.lastname: Irani
authors.forename: Peter
authors.initials: P
authors.lastname: Vogt
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.forename: Annette
authors.initials: A
authors.lastname: Boehler
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000517:prevention & control*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000276:immunology / Q000517:prevention & control; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology; D016676:Macrophages, Alveolar / Q000187:drug effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000187:drug effects* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine