Lung transplantation following

Cyclosporine is an endecapeptide isolated from fungi. It is an immunosuppressive used to prevent rejection in organ transplantation. Studies have been carried out to investigate the effectiveness of inhalation of this compound in patients receiving lung transplants. Very rapid peak plasma levels were observed followed by a slow phase but the interpretation of this behavior is compromised by the low aqueous solubility of this compound. ... 

Although not well studied, the use of aerosolized antibiotics may have additional applications in other clinical situations, including bronchiectasis, pneumonias, and management of patients following lung transplantation. 

Currently, since the safety and efficacy of SRL has not been established in liver or lung transplants, it is recommended that its use be avoided in these populations immediately following transplant. In contrast, limited data on the use of SRL in heart transplantation indicate benefit in reversing acute rejection in patients who do not respond to antilymphocyte therapy. Furthermore, SRL may slow the progression of vasculopathy, which may have an impact on chronic rejection and long-term patient survival after heart transplantation. ... 

Carrier M, White M, Perrault LP, et al. A 10-year experience with intravenous Thymoglobuline in induction of itmntmosuppression following heart transplantation. J Heart Lung Transplant 1999 18 1218-1223. 

VI. Treatment of Transient Graft Dysfunction following Lung Transplantation ... 

Two of the patients with a response to nitric oxide gas that precluded transplantation of the heart alone died one, following combined heart lung transplantation, and one, of an intercurrent pneumonia while awaiting suitable donor organs. The pulmonary histology confirmed severe and irreversible pulmonary vascular changes in both patients. 

Ischemia/reperfusion—as noted following lung transplantation (not related to rejection) and other causes of ischemia/reperfusion... 

In a case-control study in 543 lung transplant recipients, 17 (3.1%) developed squamous cell carcinomas Mer a median follow-up of 36 months [62 ]. The median time to development was 19 months after transplantation. Risk factors by univariate analysis included older age, residence in locations with high levels of sun exposure, single-lung transplantation, and duration and cumulative dose of voriconazole. The duration of voriconazole therapy and residence in locations with high sun exposure were independent risk factors by multivariate analysis. The lesions were located on the head and neck in 94% of cases and 53% had multiple lesions. After surgery at least one further independent lesion developed in 47% of patients. There was local spread and distant metastases in 7% of cases. There were no deaths. 

In a retrospective study, everolimus reversed tacrolimus-associated renal dysfunction in lung transplant recipients [38 ]. Eight of 55 patients were switched from high-dose tacrolimus maintenance therapy to everolimus (mean drug concentration 42 ng/1) in combination with low-dose tacrolimus (mean concentration 55 ng/1) and glucocorticoids. In patients with renal dysfunction before conversion to low-dose everolimus, serum creatinine returned to baseline 3 months after everolimus treatment and remained there for at least 2 year follow-up. In patients with bronchiolitis obliterans syndrome, there was maintenance of ventricular ejection fraction or a little improvement, which implies at least possibly prevention of progression. No patient had a rejection episode. There were no adverse events related to everolimus, but one patient stopped taking it after 1 year because of intolerance. 

Borro JM, Sole A, de la Torre M, Pastor A, Fernandez R, Saura A, Delgado M, Monte E, Gonzalez D. Efficiency and safety of inhaled amphotericin B hpid complex (Abelcet) in the prophylaxis of invasive fungal infections following lung transplantation. Transplant Proc 2008 40(9) 3090-3. 

LT (either single or bilateral) is a viable option for patients with end-stage pulmonary sarcoidosis refractory to medical therapy (113,198-200). From January 1995 to June 2006, 438 adults worldwide had received lung transplants for sarcoidosis (201). Long-term survival rates following LT for sarcoidosis are generally similar to other indications (198). However, in a retrospective review of U.S. data from 1995 to 2000, 30-day survival post-LT was 83% among 133 patients with sarcoidosis compared to 91% with other conditions... 

Shorr AF, Helman DL, Davie DB, et al. Sarcoidosis, race, and short-term outcomes following lung transplantation. Chest 2004 125 990-996. 

Muller C, Briegel J, Haller M, et al. Munich Lung Transplant Group. Sarcoidosis recurrence following lung transplantation. Transplantation 1996 61 1117-1119. 

In the recent ISHLT registry report, the one-, three-, and five-year prevalence rates of OB in adult lung transplant recipients (LTRs) followed-up between April 1994 and June 2005 were 10%, 30%, and 44%, respectively (1), whereas the one-, three- and five-year mortality rates from BOS were 5%, 26%, and 29%, respectively (1). OB/BOS is the single most important factor responsible for late mortality after lung transplantation, and affects 33% of LTRs who survive more than five years (1). 

Despite case reports of response to treatment with corticosteroids, larger studies have not shown any outcome benefit. Currently, accepted treatment options are limited to supportive care and prevention and treatment of infection. There is a report of three BMT recipients with IPS whose lung function improved following etanercept administration (13). Lung transplant may offer a therapeutic option for selected patients. Although the pneumonitis resolves in about 31%, the clinical course of IPS is often comphcated by viral and fungal infections, pneumothorax, pneumomediastinum, subcutaneous emphysema, pulmonary fibrosis, and autoimmune polyserositis (5). The case fatality of IPS is... 

Noji H, Shichishima T, Ogawa K, et al. Transfusion-related acute lung injury following allogeneic bone marrow transplantation in a patient with acute lymphoblastic leukemia. Intern Med 2004 43(11) 1068-1072. 

Parker LA, Novotny DB. Recurrent alveolar proteinosis following double lung transplantation. Chest 1997 111(5) 1457-1458. 

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