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J Thorac Cardiovasc Surg 2004;127:1126-1132
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

International experience with conversion from cyclosporine to tacrolimus for acute and chronic lung allograft rejection

^a Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
^b Department of Pulmonology, Erasme University Hospital, Brussels, Belgium
^c Department of Pulmonology, Freeman Hospital, Newcastle, United Kingdom
^d Department of Pulmonology, University of Hannover, Hannover, Germany
^e Department of Pulmonology, St Vincent's Hospital, Sydney, Australia
^f Department of Pulmonology, University of Toronto, Toronto, Canada
^g Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium
^h Department of Pulmonology, University of Geneva, Geneva, Switzerland
ⁱ Department of Thoracic Surgery, University of Rome, Rome, Italy
^j Department of Cardiovascular Surgery, University of Kiel, Kiel, Germany
^k Department of Pulmonology, University of Lausanne, Lausanne, Switzerland
^l Department of Respiratory Medicine, The Alfred Hospital, Sydney, Australia
^m Department of Cardiothoracic Surgery, University of Munich, Munich, Germany
ⁿ Department of Medical Statistics, University of Vienna, Vienna, Austria

Received for publication April 9, 2003; revisions received November 3, 2003; accepted for publication November 10, 2003.

^* Address for reprints: Walter Klepetko, MD, Department of Cardiothoracic Surgery, University of Vienna, Austria, Währinger Gürtel 18-20, A-1090 Vienna, Austria
walter.klepetko{at}akh-wien.ac.at

OBJECTIVE: A retrospective study involving 13 institutions was performed to assess the efficacy of conversion from cyclosporine (INN: ciclosporin) to tacrolimus.

METHODS: Data from 244 patients were analyzed. Indications for conversion were recurrent-ongoing rejection (n = 110) and stage 1 to 3 bronchiolitis obliterans syndrome (n = 134).

RESULTS: The incidence of acute rejection decreased significantly within 3 months after versus before the switch from cyclosporine to tacrolimus (P < .01). For patients with recurrent-ongoing rejection, the forced expiratory volume in 1 second decreased by 1.96% of predicted value per month (P = .08 vs zero slope) before and increased by 0.34% of predicted value per month (P = .32 vs zero slope) after conversion (P < .06). For patients with stage 1 to 3 bronchiolitis obliterans syndrome, a significant reduction of rejection episodes was observed (P < .01). In single transplant recipients a decrease of the forced expiratory volume in 1 second averaged 2.25% of predicted value per month (P < .01 vs zero slope) before and 0.29% of predicted value per month after conversion. Corresponding values for bilateral transplant recipients were 3.7% of predicted value per month (P < .01 vs zero slope) and 0.9% of predicted value per month (P = 0.04 vs zero slope), respectively. No significant difference in the incidence of infections within 3 months before and after conversion was observed.

CONCLUSIONS: Conversion from cyclosporine to tacrolimus after lung transplantation is associated with reversal of recurrent-ongoing rejection. Conversion for bronchiolitis obliterans syndrome allows short-term stabilization of lung function in most patients.

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