Conversion From Cyclosporine to Tacrolimus Stabilizes the Course of Lung Function in Lung Transplant Recipients With Bronchiolitis Obliterans Syndrome

• Published in: Transplantation proceedings Vol. 39; no. 7; pp. 2416 - 2419
• Main Authors: Borro, J.M, Bravo, C, Solé, A, Usetti, P, Zurbano, F, Lama, R, De la Torre, M, Román, A, Pastor, A, Laporta, R, Cifrián, J.M, Santos, F
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2007; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Bronchiolitis Obliterans - immunology; Chronic obstructive pulmonary disease, asthma; Cyclosporine - adverse effects; Female; Forced Expiratory Volume - drug effects; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Lung Diseases - classification; Lung Diseases - surgery; Lung Transplantation - immunology; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Complications - immunology; Respiratory Function Tests; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - therapeutic use; Tissue Donors; Tissue, organ and graft immunology; Calcineurin inhibitor; Lung; Transplantation; Homotransplantation; Respiratory system; Lung function; Surgery; Bronchus disease; Graft; Bronchiolitis obliterans; Ciclosporin; Protein synthesis inhibitor; Stability; Respiratory disease; Lactone; Macrolide; Conversion; Syndrome; Immunomodulator; Medicine; Drug conversion; Treatment; Tacrolimus; Immunosuppressive agent; Antibacterial agent; Physicochemical properties
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.06.071

Abstract Bronchiolitis obliterans syndrome (BOS) continues to be the main factor limiting the long-term survival of lung transplant recipients. The objective of this study was to prospectively assess the impact of conversion from cyclosporine (CsA) to tacrolimus on lung function in patients who developed BOS while receiving CsA-based immunosuppressive therapy. A total of 79 patients with BOS were included in the study. Sixty percent of patients had stage II or III BOS according to the International Society for Heart and Lung Transplantation criteria. Mean time from transplantation was 30.4 ± 21.9 months and all patients were on CsA therapy at enrollment in the study, with mean trough levels of 232.75 ± 98.26 ng/mL. After conversion, tacrolimus trough levels were 11.0 ± 3.6 ng/mL at 3 months and 9.0 ± 3.4 ng/mL at 12 months. Sixteen deaths occurred during the first year postconversion, 56% of which were due to respiratory failure. Comparison of forced expiratory volume in 1 second (FEV1 ) preconversion versus postconversion showed a change in the slope of the FEV1 -time curve. The slope of the preconversion curve was −0.44 versus a zero slope, whereas the slope of the postconversion curve was 0.005, with a statistically significant difference between both slopes. This change in slopes, which was also seen in FEV1% , suggests that lung function loss closed after conversion from CsA to tacrolimus supporting this therapeutic strategy in lung transplant recipients with BOS treated with CsA.