title: Effects of prophylactic use of sirolimus on bronchiolitis obliterans syndrome development in lung transplant recipients.
abstract: BACKGROUND
  Sirolimus (SIR) has been shown to stabilize the lung function in lung transplant recipients with bronchiolitis obliterans syndrome (BOS). However, there is no long-term data on the prophylactic use of SIR in lung transplant recipients. This retrospective study examines the effects of SIR in the prevention of BOS.
  
  
  METHODS
  From 1999 to 2009, 24 lung transplant recipients whose maintenance immunosuppression regimen consisted of tacrolimus (Tac), mycophenolate mofetil (MMF) or azathioprine (AZA), and prednisone (Pred), were switched to Tac, SIR, and Pred at 1 year after transplantation. From these 24 patients, 5 developed side effects that necessitated the cessation of SIR within 1 year, while 19 patients tolerated long-term use of SIR. The clinical outcomes of these 19 patients (SIR group) were compared with 22 lung transplant recipients whose immunosuppression regimen consisted of Tac, MMF or AZA, and Pred from the time of transplant (MMF group). Survival rates and freedom from BOS were calculated by the Kaplan-Meier method.
  
  
  RESULTS
  The SIR group had a lower incidence of BOS and viral infection (p = 0.05), and higher survival rates (p = 0.004). The SIR group had lower levels of Tac and received less Pred. The incidences of acute rejection, carcinoma, hypertension, and diabetes were similar between both groups.
  
  
  CONCLUSIONS
  Results from this study suggest that conversion to SIR 1 year after lung transplantation improves survival and decreases the development of BOS. Randomized studies with higher number of patients are needed to determine the prophylactic efficacy of sirolimus in preventing the development of BOS.
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida.
authors.forename: Vikas Y
authors.initials: VY
authors.lastname: Sacher
authors.affiliation: Division of Pulmonology, Jackson Health System, Miami, Florida.
authors.forename: Debra
authors.initials: D
authors.lastname: Fertel
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida.
authors.forename: Karan
authors.initials: K
authors.lastname: Srivastava
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida.
authors.forename: Anthony
authors.initials: A
authors.lastname: Panos
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida.
authors.forename: Dao
authors.initials: D
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida.
authors.forename: Tammy
authors.initials: T
authors.lastname: Baxter
authors.affiliation: Department of Medicine, University of Miami, Miami, Florida.
authors.forename: Shirin
authors.initials: S
authors.lastname: Shafazand
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida. Electronic address: spham@smail.umaryland.edu.
authors.forename: Si M
authors.initials: SM
authors.lastname: Pham
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: 12