JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Kenneth R. McCurry
Brack G. Hattler
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McCurry, K. R.
Right arrow Articles by Starzl, T. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McCurry, K. R.
Right arrow Articles by Starzl, T. E.
Related Collections
Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2005;130:528-537
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Early outcomes in human lung transplantation with Thymoglobulin or Campath-1H for recipient pretreatment followed by posttransplant tacrolimus near-monotherapy

Kenneth R. McCurry, MD a , * , Aldo Iacono, MD b , Adrianna Zeevi, PhD a , b , c , d , Samuel Yousem, MD c , Alin Girnita, MD d , Shahid Husain, MD b , Diana Zaldonis, BSN a , Bruce Johnson, MD b , Brack G. Hattler, MD a , Thomas E. Starzl, MD, PhD a , d

a Department of Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pa
b Department of Medicine, The University of Pittsburgh Medical Center, Pittsburgh, Pa
c Department of Pathology, The University of Pittsburgh Medical Center, Pittsburgh, Pa
d Thomas E. Starzl Transplantation Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pa

Received for publication April 20, 2004; revisions received September 8, 2004; accepted for publication September 30, 2004.

* Address for reprints: Kenneth R. McCurry, MD, 200 Lothrop St, Suite C-700, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213 (Email: mccurrykr{at}upmc.edu).

OBJECTIVES: Acute and chronic rejection remain unresolved problems after lung transplantation, despite heavy multidrug immunosuppression. In turn, the strong immunosuppression has been responsible for mortality and pervasive morbidity. It also has been postulated to interdict potential mechanisms of alloengraftment.

METHODS: In 48 lung recipients we applied 2 therapeutic principles: (1) recipient pretreatment with antilymphoid antibody preparations (Thymoglobulin [SangStat, Fremont, Calif] or Campath [alemtuzumab; manufactured by ILEX Pharmaceuticals, LP, San Antonio, Tex; distributed by Berlex Laboratories, Richmond, Calif]) and (2) minimal posttransplant immunosuppression with tacrolimus monotherapy or near-monotherapy. Our principal analysis was of the events during the critical first 6 posttransplant months of highest immunologic and infectious disease risk. Results were compared with those of 28 historical lung recipients treated with daclizumab induction and triple immunosuppression (tacrolimus-prednisone-azathioprine).

RESULTS: Recipient pretreatment with both antilymphoid preparations allowed the use of postoperative tacrolimus monotherapy with prevention or control of acute rejection. Freedom from rejection was significantly greater with Campath than with Thymoglobulin (P = .03) or daclizumab (P = .05). After lymphoid depletion with Thymoglobulin or Campath, patient and graft survival at 6 months was 90% or greater. Patient and graft survival after 9 to 24 months is 84.2% in the Thymoglobulin cohort, and after 10 to 12 months, it is 90% in the Campath cohort. There has been a subjective improvement in quality of life relative to our historical experience.

CONCLUSION: Our results suggest that improvements in lung transplantation can be accomplished by altering the timing, dosage, and approach to immunosuppression in ways that might allow natural mechanisms of alloengraftment and diminish the magnitude of required maintenance immunosuppression.




This article has been cited by other articles:


Home page
 Proc Am Thorac SocHome page
J. A. Belperio, S. S. Weigt, M. C. Fishbein, and J. P. Lynch III
Chronic Lung Allograft Rejection: Mechanisms and Therapy
Proceedings of the ATS, January 15, 2009; 6(1): 108 - 121.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
Y. Toyoda, J. Thacker, R. Santos, D. Nguyen, J. Bhama, C. Bermudez, R. Kormos, B. Johnson, M. Crespo, J. Pilewski, et al.
Long-Term Outcome of Lung and Heart-Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension
Ann. Thorac. Surg., October 1, 2008; 86(4): 1116 - 1122.
[Abstract] [Full Text] [PDF]

Home page
 J Intensive Care MedHome page
J. L. Taylor and S. M. Palmer
Critical Care Perspective on Immunotherapy in Lung Transplantation
J Intensive Care Med, December 1, 2006; 21(6): 327 - 344.
[Abstract] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. Estenne and R. M. Kotloff
Update in transplantation 2005.
Am. J. Respir. Crit. Care Med., March 15, 2006; 173(6): 593 - 598.
[Full Text] [PDF]

Home page
 NEJMHome page
M. M. DeCamp Jr.
Inhaled Cyclosporine -- A Breath of Fresh Air?
N. Engl. J. Med., January 12, 2006; 354(2): 191 - 193.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2005 by The American Association for Thoracic Surgery.