HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert J. Keenan Bartley P. Griffith Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Keenan, R. J. Articles by Griffith, B. P. Search for Related Content PubMed PubMed Citation Articles by Keenan, R. J. Articles by Griffith, B. P.

J Thorac Cardiovasc Surg 1997;113:335-341
© 1997 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

TREATMENT OF REFRACTORY ACUTE ALLOGRAFT REJECTION WITH AEROSOLIZED CYCLOSPORINE IN LUNG TRANSPLANT RECIPIENTS

Supported by Food and Drug Administration drug grant RFA-FD-OP-90-1.

Received for publication May 1, 1996 revisions requested June 17, 1996; revisions received Sept. 6, 1996 accepted for publication Sept. 11, 1996. Address for reprints: Robert J. Keenan, MD, Division of Cardiothoracic Surgery, C-702 PUH, University of Pittsburgh Medical Center, Pittsburgh, PA 15213.

Abstract

Lung transplant recipients who have persistent acute cellular rejection are at increased risk for the development of chronic rejection, the leading cause of reduced long-term survival. This study evaluated the use of aerosolized cyclosporine as rescue therapy for unremitting acute rejection. Between June 1993 and March 1996, 18 patients with rejection that failed to resolve after therapy with pulse steroids and antilymphocyte globulin were enrolled in the study. Aerosolized cyclosporine A (300 mg) treatment was initiated for 10 consecutive days followed by a maintenance regimen of 3 days per week. Efficacy was assessed by graft histologic and pulmonary function testing. With the use of linear regression, results in these patients were compared with those in 23 control patients, matched for histologic acute rejection, who had continued to receive conventional rescue therapy. Two patients were unable to tolerate the treatments and were withdrawn from the study. Significant improvement in histologic rejection occurred in 14 of the remaining 16 patients after a mean of 37 days of aerosolized cyclosporine therapy. Measures of forced vital capacity and forced expiratory volume in 1 second (change in percent predicted/100 days plus or minus the standard error) increased over time in the treated patients whereas the condition of control patients declined despite repeated attempts at conventional rescue (forced vital capacity, aerosolized cyclosporine group, 4.6 ± 2.9 vs control group -8.1 ± 1.9, p = 0.001; forced expiratory volume in 1 second, aerosolized cyclosporine group, 2.1 ± 4.4 vs control group -9.8 ± 2.6, p = 0.043). Renal and hepatic toxicity during cyclosporine therapy was not observed. The incidence of acute histologic rejection (A2) decreased from 2.49 ± 0.68 episodes/100 days before aerosolized cyclosporine therapy to 0.72 ± 0.3 episodes/100 days (p < 0.05). In summary, aerosolized cyclosporine is a safe and effective therapy for acute rejection that has failed to improve with conventional treatment.

This article has been cited by other articles:

				N. Ide, T. Nagayasu, K. Matsumoto, T. Tagawa, K. Tanaka, T. Taguchi, Y. Sumida, and M. Nakashima Efficacy and safety of inhaled tacrolimus in rat lung transplantation J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 548 - 553. [Abstract] [Full Text] [PDF]

				A. T. Iacono, B. A. Johnson, W. F. Grgurich, J. G. Youssef, T. E. Corcoran, D. A. Seiler, J. H. Dauber, G. C. Smaldone, A. Zeevi, S. A. Yousem, et al. A Randomized Trial of Inhaled Cyclosporine in Lung-Transplant Recipients N. Engl. J. Med., January 12, 2006; 354(2): 141 - 150. [Abstract] [Full Text] [PDF]

				D. S. Wilkes, T. M. Egan, and H. Y. Reynolds Lung Transplantation: Opportunities for Research and Clinical Advancement Am. J. Respir. Crit. Care Med., October 15, 2005; 172(8): 944 - 955. [Abstract] [Full Text] [PDF]

				T.E. Corcoran, G.C. Smaldone, J.H. Dauber, D.A. Smith, K.R. McCurry, G.J. Burckart, A. Zeevi, B.P. Griffith, and A.T. Iacono Preservation of post-transplant lung function with aerosol cyclosporin Eur. Respir. J., March 1, 2004; 23(3): 378 - 383. [Abstract] [Full Text] [PDF]

				A.T. Iacono, T.E. Corcoran, B.P. Griffith, W.F. Grgurich, D.A. Smith, A. Zeevi, G.C. Smaldone, K.R. McCurry, B.A. Johnson, and J.H. Dauber Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans Eur. Respir. J., March 1, 2004; 23(3): 384 - 390. [Abstract] [Full Text] [PDF]

				C. Knoop, A. Haverich, and S. Fischer Immunosuppressive therapy after human lung transplantation Eur. Respir. J., January 1, 2004; 23(1): 159 - 171. [Abstract] [Full Text] [PDF]

				L. M. McDevitt Immunosuppressive Agents on the Horizon Journal of Pharmacy Practice, December 1, 2003; 16(6): 434 - 441. [Abstract] [PDF]

				A. DeVito Dabbs, L. A. Hoffman, A. T. Iacono, C. L. Wells, W. Grgurich, T. G. Zullo, K. R. McCurry, and J. H. Dauber Pattern and Predictors of Early Rejection After Lung Transplantation Am. J. Crit. Care., November 1, 2003; 12(6): 497 - 507. [Abstract] [Full Text] [PDF]

				G. V. Letsou, H. J. Safi, M. J. Reardon, M. Ergenoglu, Z. Li, C. N. Klonaris, J. C. Baldwin, B. E. Gilbert, and J. C. Waldrep Pharmacokinetics of liposomal aerosolized cyclosporine A for pulmonary immunosuppression Ann. Thorac. Surg., December 1, 1999; 68(6): 2044 - 2048. [Abstract] [Full Text] [PDF]

				J W K van den Berg, D S Postma, G H Koëter, and W van der Bij New immunosuppressive drugs and lung transplantation: last or least? Thorax, June 1, 1999; 54(6): 550 - 553. [Full Text]