Tacrolimus Therapy for Persistent or Recurrent Acute Rejection After Lung Transplantation

Background: Because the severity, frequency, and duration of acute rejection have been linked to the risk of chronic allograft rejection, controlling persistent or recurrent acute rejection is paramount. Tacrolimus has been effective in the management of recalcitrant rejection in other solid organ transplants, and the initial experience in lung transplantation has been favorable. In this study, the impact of changing from a cyclosporine-based to a tacrolimus-based immunosuppressive regimen in lung transplant recipients with persistent or recurrent acute rejection was analyzed.

Methods: The incidence and severity of acute rejection were retrospectively analyzed in 14 lung transplant recipients who were switched from cyclosporine to tacrolimus maintenance immunosuppression because of persistent or recurrent, biopsy-proven acute rejection.

Results: Recipients had been treated for acute rejection an average of 2.6 times before changing from cyclosporine to tacrolimus, and 3 recipients had a course of OKT3 therapy. Tacrolimus therapy was begun 238+/-180 days after transplantation, and the mean follow-up period on tacrolimus treatment was 330+/-201 days. After the changeover from cyclosporine to tacrolimus, the number of episodes of acute rejection per recipient decreased (4.3+/-2.1 to 0.4+/-0.5; p=.0001), the average histologic grade of rejection receded (1.3+/-0.4 to 0.3+/-0.4; p=.0001), and the incidence of acute rejection declined (2.4+/-1.5 to 0.1+/-0.3 episodes per 100 patient-days; p=.0001).

Conclusions: Conversion from a cyclosporine- to a tacrolimus-based maintenance immunosuppressive regimen is an effective approach for managing persistent or recurrent allograft rejection after lung transplantation.