Tacrolimus and mycophenolate mofetil as first line immunosuppression after lung transplantation

Authors: Neurohr, Claus; Huppmann, Patrick; Zimmermann, Gregor¹; Leuchte, Hanno¹; Baumgartner, Rainer¹; Hatz, Rudolf²; Frey, Lorenz³; Überfuhr, Peter⁴; Bittmann, Iris⁵; Behr, Jürgen¹; Reichart, Bruno⁴

Source: Transplant International, Volume 22, Number 6, June 2009 , pp. 635-643(9)

Publisher: Wiley-Blackwell

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Abstract:

Summary

The optimal maintenance therapy after lung transplantation remains to be established. The aim of this study was to analyse the impact of tacrolimus and mycophenolate mofetil (MMF) as first line immunosuppression on long-term survival and Bronchiolitis Obliterans Syndrome (BOS). From January 1996 through December 2006, all 155 recipients receiving tacrolimus and MMF as maintenance immunosuppression were included in this study. Tacrolimus and MMF was discontinued in 36 patients (23.2%). The overall survival rates were 91.6% at 6 months, 86.4% at 1 year, 74.9% at 3 years, 60.3% at 5 years and 32.4% at 10 years. The overall freedom from acute rejection was 74.6%, 63.2% and 59.4% at 1, 3, and 5 years respectively. The overall BOS-free survival was 95.6% at 1 year, 88.4% at 3 years, 69.5% at 5 years and 30.5% at 10 years. The development of BOS ≥ 1 was associated with a significantly increased risk of death and reduced long-term survival. The combination of tacrolimus and MMF offers safe and reliable maintenance immunosuppression after lung transplantation. However, substantial improvements of long-term survival and freedom from BOS might only be achieved by a change in organ allocation policies and patient management beyond differential immunosuppressive protocols.

Keywords: lung transplantation; mycophenolate mofetil; survival; tacrolimus

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1432-2277.2009.00843.x

Affiliations: 1: Department of Int. Medicine I, Division of Pulmonary Diseases, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany 2: Department of Surgery and Thoracic Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany 3: Department of Anesthesiology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany 4: Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany 5: Institute of Pathology, Ludwig-Maximilians University, Munich, Germany

Publication date: 2009-06-01

Tacrolimus and mycophenolate mofetil as first line immunosuppression after lung transplantation

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