Conversion to sirolimus and mycophenolate can attenuate the progression of bronchiolitis obliterans syndrome and improves renal function after lung transplantation.

Abstract:

BACKGROUND:Bronchiolitis obliterans syndrome (BOS) is the major problem after lung and heart-lung transplantation (LTx/HLTx). Sirolimus (Sir) and Mycophenolate (MMF) showed a promising efficacy in the treatment of BOS in animal models. The first clinical experience in converting LTx/HLTx-recipients with BOS from calcineurin inhibitor-(CNI)-based immunosuppression to a Sir-MMF based immunosuppression is reported herein. METHODS:Six LTx- and five HLTx-recipients (eight men; 0.9 to 8 years after transplantation) with CNI-based immunosuppression (plus MMF) in whom BOS was diagnosed were included in the study. Mean patient age was 37+/-13 years (range 17-62 years). Sir was started with 6 mg and continued adjusted to according target trough levels (8-14 ng/ml). Subsequently, the CNIs were tapered down and finally stopped. Follow up included self determined pulmonary function tests, microbiological screening, chest radiographs, and laboratory studies RESULTS:Two acute rejection episodes occurred during the study period. The incidence of infection was 2.2+/-1.3 infections/patient-year after conversion. Mean FEV1 decreased after a mean follow up of 14.8+/-1.4 months: from 2.1+/-0.7 l prior conversion to 1.3+/-0.6l after conversion (P=0.03). However, graft function remained stable in three patients and progression of BOS slowed down in three patients. Overall, 2 of 10 patients died due to ongoing BOS while awaiting retransplantation CONCLUSIONS:After BOS was diagnosed, conversion to MMF and Sir stabilized graft function only in some of the converted patients. Therefore, earlier administration of Sir-based immunosuppression might be a more promising approach. Whether conversion to CNI-free immunosuppression can actually ameliorate the extent or progression of BOS has to be investigated in randomized trials.

journal_name

Transplantation

journal_title

Transplantation

authors

Groetzner J,Wittwer T,Kaczmarek I,Ueberfuhr P,Strauch J,Nagib R,Meiser B,Franke U,Reichart B,Wahlers T

doi

10.1097/01.tp.0000195781.02268.5e

subject

Has Abstract

pub_date

2006-02-15 00:00:00

pages

355-60

issue

3

eissn

0041-1337

issn

1534-6080

pii

00007890-200602150-00010

journal_volume

81

pub_type

临床试验,杂志文章
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    doi:10.1097/00007890-199005000-00001

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  • Quantitative serological analysis of a rabbit anti-rat lymphocyte serum and preliminary biochemical characterisation of the major antigen recognised.

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    更新日期:1990-03-01 00:00:00

  • Administration of hydrogen-rich saline protects mice from lethal acute graft-versus-host disease (aGVHD).

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    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31827e6b23

    authors: Qian L,Mei K,Shen J,Cai J

    更新日期:2013-03-15 00:00:00

  • The effect of two new immunosuppressive agents, FK506 and didemnin B, in murine pregnancy.

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  • Fungal infections in liver transplant recipients.

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    pub_type: 杂志文章

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  • The Relationship of the Severity and Category of Acute Rejection With Intimal Arteritis Defined in Banff Classification to Clinical Outcomes.

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    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0000000000000640

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    pub_type: 杂志文章

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    更新日期:1987-02-01 00:00:00

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    更新日期:1995-11-27 00:00:00

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    pub_type: 杂志文章

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    更新日期:1992-10-01 00:00:00

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    pub_type: 杂志文章

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    authors: Fox A,Koulmanda M,Mandel TE,van Rooijen N,Harrison LC

    更新日期:1998-12-15 00:00:00

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    pub_type: 杂志文章

    doi:10.1097/00007890-198801000-00027

    authors: Halloran P,Aprile M

    更新日期:1988-01-01 00:00:00

  • Tacrolimus in cardiac transplantation: efficacy and safety of a novel dosing protocol.

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    journal_title:Transplantation

    pub_type: 临床试验,杂志文章

    doi:10.1097/00007890-200210270-00014

    authors: Baran DA,Galin I,Sandler D,Segura L,Cheng J,Courtney MC,Correa R,Chan M,Fallon JT,Spielvogel D,Lansman SL,Gass AL

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    pub_type: 杂志文章

    doi:10.1097/00007890-197503000-00003

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    更新日期:1975-03-01 00:00:00

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    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

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    更新日期:1987-04-01 00:00:00

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    pub_type: 杂志文章

    doi:10.1097/00007890-200006270-00028

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    pub_type: 杂志文章

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