title: Calcineurin inhibitors and Clostridium difficile infection in adult lung transplant recipients: the effect of cyclosporine versus tacrolimus.
abstract: BACKGROUND
  Tacrolimus (FK506) has a superior immunosuppressive effect compared with cyclosporine (CSA) without a significant increase in generalized infectious complications. Differences in specific infections such as Clostridium difficile (CDI) have not been reported. We investigated the relationship between calcineurin inhibitors and CDI, hypothesizing that choice of calcineurin inhibitor (CSA or FK506) after lung transplantation would have no effect on the incidence of CDI.
  
  
  METHODS
  We performed a retrospective chart review of lung transplant recipients between June 1, 2000, and December 31, 2005, at a single institution. Positive CDI assays through December 11, 2011, were also recorded. We used Student's t- and chi-squared tests (α = 0.05) to compare CSA and FK506 groups. We calculated adjusted hazard ratios for CDI using Cox proportional hazard models.
  
  
  RESULTS
  We identified 217 lung transplant recipients: 106 patients in the CSA group and 111 patients in the FK506 group. A total of 31 patients (27.9%) in the FK506 group developed CDI postoperatively compared with 20 patients (18.9%) in the CSA group (P = 0.16). The adjusted hazard ratio for CDI in the FK506 group was not significantly higher (1.53; 95% confidence interval, 0.78-2.98). There was no significant difference in the intensive care unit or total length of stay, in-hospital incidence rate, time to first CDI episode, or recurrence rate between groups.
  
  
  CONCLUSIONS
  The CDI rates were not significantly higher in the FK506 group than the CSA group in our study. These data are consistent with previous studies on FK506 that show no increase in infectious complications over CSA, and demonstrate its continued safety in lung transplantation.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA. jtlee04@gmail.com
authors.forename: Janet T
authors.initials: JT
authors.lastname: Lee
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: Rosemary F
authors.initials: RF
authors.lastname: Kelly
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Dunitz
authors.forename: Marshall I
authors.initials: MI
authors.lastname: Hertz
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Shumway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D002648:Child; D016360:Clostridioides difficile; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015994:Incidence; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009894:Opportunistic Infections / Q000453:epidemiology / Q000276:immunology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus
keywords: Calcineurin inhibitors; Clostridium difficile; Cyclosporine; Immunosuppression; Lung transplantation; Tacrolimus; Transplant infections