Lung transplantation immunosuppression

Cyclosporine A is a powerful immunosuppressive drug intended for preventing rejection of kidney, heart, and lung transplants. 

Lung transplantation-bronchial anastomotic dehiscence Cases of bronchial anastomotic dehiscence, most fatal, have been reported in de novo lung transplant patients when sirolimus has been used as part of an immunosuppressive regimen. The safety and efficacy of sirolimus as immunosuppressive therapy have not been established in liver or lung transplant patients, and therefore, such use is not recommended. 

Reichenspurner H Overview of tacrolimus-based immunosuppression after heart or lung transplantation. J Heart Lung Transplant 2005 24 119. [PMID 15701425]... 

Lung transplantation has been used in the treatment of lung disease associated with ax-antitrypsin deficiency. Survival is the same as for patients undergoing the procedure for chronic obstructive pulmonary disease. As with any transplantation, lifelong immunosuppression is necessary. 

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. ... 

In two patients who had lung transplants and were taking an immunosuppressive regimen that included ciclosporin, the addition of clindamycin (600 mg tds) resulted in a significant reduction in ciclosporin concentrations (68). 

Taylor DO, Barr ML, Radovancevic B, Renlund DG, Mentzer RM Jr, Smart FW, Tolman DE, Frazier OH, Young JB, VanVeldhuisen P. A randomized, multicenter comparison of tacrohmus and cyclosporine immunosuppressive regimens in cardiac transplantation decreased hyperlipidemia and hypertension with tacrohmus. J Heart Lung Transplant 1999 18(4) 336-45. 

Brann WM, Bennett LE, Keck BM, Hosenpud JD. Morbidity, functional status, and Immunosuppressive therapy after heart transplantation an analysis of the joint international Society for Heart and LungTransplantation/United Network for Organ Sharing Thoracic Registry. J Heart Lung Transplant 1998 17 374-382. 

Lewis RM,Van Buren CT, Radovancevic B, Frazier OFi, Janney RP, Powers PL, Golden DL, Giannakis JG, MacrisMP, Kerman RH, et al. impact of long-term cyclosporine immunosuppressive therapy on native kidneys versus renal allografts serial renal function in heart and kidney transplant recipients. J Fleart Lung Transplant 1991 10 63-70. 

Kur F, Reichenspurner H, Meiser BM, Welz A, Furst H, Muller QVogelmeierC, Schwaibimaier M, Briegel J, Reichart B. Tacrolimus (FK506) as primary Immunosuppressant after lung transplantation.Thorac Cardiovasc Surg 1999 47 174-178. 

Cyclosporine was approved for transplant immunosuppression in 1983. It is administered to prevent organ rejection after transplant of kidney, liver, lung, heart, or bone marrow. In addition, it has been given to patients with nephrotic syndrome, rheumatoid arthritis, psoriasis, severe Crohn s disease, and for other medical conditions. 

The most severe CMV infections are seen in those individuals who acquire their primary infection while immunocompromised. In persons with AIDS, CMV disease rarely occurs when the CD4+ cell count is above 100 cells/mm the most common clinical presentations are retinitis, esophagitis, and colitis. In transplant recipients, the occurrence and severity of CMV disease are related to the CMV serostatus of the organ donor and recipient, the type of organ transplanted, and the overall degree of immunosuppression. For example, CMV disease tends to be more severe in lung transplant recipients than in renal transplant recipients. For aU types of organ recipients, the most severe disease occurs... 

P. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 1999 18 336-345. 

Dr. James Hardy performed the first lung transplantation at the University of Mississippi in 1963. The immunosuppressive regimen at the time was azathio-prine, steroids, and thymic radiation. Unfortunately, the lung transplant recipient died 18 days later secondary to renal failure however, the lung allograft had not... 

Gude E, Gullestad L, Arora S, Simonsen S, Hoel I, Hartmann A, Holdaas H, Fiane AE, Geiran OR, Andreassen AK. Benefit of early conversion from CNI-based to everolimus-based immunosuppression in heart transplantation. J Heart Lung Transplant 2010 29 (6) 641-7. 

Glanville AR, Baldwin JC, Burke CM, et al. Obliterative bronchioUtis after heart-lung transplantation apparent arrest by augmented immunosuppression. Ann Intern Med 1987 107 30( 04. 

Whitford H, Walters EH, Lewey B, et al. Addition of inhaled corticosteroids to systemic immunosuppression after lung transplantation a double-bUnd, placebo-controlled trial. Transplantation 2002 73 1793-1797. 

The treatment of BO consists of corticosteroids and augmented immunosuppression, targeting chronic GVHD. However, a minority of patients shows clinical improvement (5). There is a report of eight BMT recipients with BO whose pulmonary function improved after treatment with azithromycin (6) and one BMT recipient treated with infliximab (7). In addition to immunosuppression and anti-inflammatory therapy, prophylaxis against Pneumocystis jirovecii pneumonia and Streptococcus pneumoniae should be provided to patients with BO. In selected patients with respiratory failure secondary to BO, lung transplantation may be an option (1). 

Hong, Y. S., Laks, H., Cui, G. G., Chong, T., and Sen, L. Y. 2002. Localized immunosuppression in the cardiac allograft induced by a new liposome-mediated IL-10 gene therapy. Journal of Heart and Lung Transplantation, 21,1188-1200. 

With early diagnosis, no treatment maybe needed. With symptomatic, progressive, or impairing chronic beryllium disease, oral corticosteroids are used. Other immunosuppressive agents and lung transplantation should be considered if there is no response to corticosteroids. Removal of sensitized individuals and those with CBD from further heryllium exposure is generally recommended, hut it is unclear whether this influences the clinical course of the disease. 

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