Document Detail


Early outcomes in human lung transplantation with Thymoglobulin or Campath-1H for recipient pretreatment followed by posttransplant tacrolimus near-monotherapy.
MedLine Citation:
PMID:  16077423     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Kenneth R McCurry; Aldo Iacono; Adrianna Zeevi; Samuel Yousem; Alin Girnita; Shahid Husain; Diana Zaldonis; Bruce Johnson; Brack G Hattler; Thomas E Starzl
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  130     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-03     Completed Date:  2005-10-20     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  528-37     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, The University of Pittsburgh Medical Center, PA 15216, USA. mccurrykr@upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antibodies, Monoclonal / therapeutic use*
Antibodies, Monoclonal, Humanized
Antibodies, Neoplasm / therapeutic use*
Antilymphocyte Serum / therapeutic use*
Female
Graft Rejection / drug therapy*,  prevention & control
Graft Survival / drug effects
Humans
Immunosuppressive Agents / therapeutic use*
Lung Transplantation / immunology*
Male
Middle Aged
Prednisone / therapeutic use
Survival Analysis
Tacrolimus / therapeutic use*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 DK029961-19/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Neoplasm; 0/Antilymphocyte Serum; 0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 3A189DH42V/alemtuzumab; 53-03-2/Prednisone
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