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Tacrolimus as rescue therapy for bronchiolitis obliterans syndrome.
J Heart Lung Transplant 1997; 16(9):905-12JH

Abstract

BACKGROUND

Chronic lung allograft rejection manifested by sustained declines in lung function is the most common cause of late death after lung transplantation. Numerous strategies have shown variable results. We sought to evaluate the effect of FK506 (tacrolimus) on bronchiolitis obliterans syndrome (BOS) after lung transplantation.

METHODS

A single-center open study was conducted of 15 patients whose treatment was converted to tacrolimus from cyclosporine. Of the 15, 12 patients had BOS characterized by sustained loses in lung function while receiving cyclosporine. Rate of decline of forced expiratory volume in 1 second (FEV1) for the 12 patients was calculated before and after administration of tacrolimus. Biochemical changes before and after conversion were compared for the entire group.

RESULTS

Median monthly rate of decline in FEV1 was significantly reduced after administration of tacrolimus (5.3% vs 1.1%; p = 0.002). Forced vital capacity did not change significantly. No subjects experienced at least a 10% improvement in FEV1. At least a 10% further decline in FEV1 was noted in five subjects, and seven subjects had no change (i.e., within 10% of baseline). A minor nonsignificant increase in creatinine occurred after administration of tacrolimus. Blood cell count, electrolytes, and liver enzymes remained unchanged. The median change in fasting blood glucose was +0.7 mmol/L (p = 0.02).

CONCLUSION

Although tacrolimus does not reverse changes in FEV1 with BOS, in this nonrandomized study it seemed to be associated with a decrease in the rate of decline in lung function and no significant sustained toxicity. Further studies are necessary to substantiate this observation.

Authors+Show Affiliations

Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9322139

Citation

Kesten, S, et al. "Tacrolimus as Rescue Therapy for Bronchiolitis Obliterans Syndrome." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 16, no. 9, 1997, pp. 905-12.
Kesten S, Chaparro C, Scavuzzo M, et al. Tacrolimus as rescue therapy for bronchiolitis obliterans syndrome. J Heart Lung Transplant. 1997;16(9):905-12.
Kesten, S., Chaparro, C., Scavuzzo, M., & Gutierrez, C. (1997). Tacrolimus as rescue therapy for bronchiolitis obliterans syndrome. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 16(9), pp. 905-12.
Kesten S, et al. Tacrolimus as Rescue Therapy for Bronchiolitis Obliterans Syndrome. J Heart Lung Transplant. 1997;16(9):905-12. PubMed PMID: 9322139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tacrolimus as rescue therapy for bronchiolitis obliterans syndrome. AU - Kesten,S, AU - Chaparro,C, AU - Scavuzzo,M, AU - Gutierrez,C, PY - 1997/10/10/pubmed PY - 1997/10/10/medline PY - 1997/10/10/entrez SP - 905 EP - 12 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 16 IS - 9 N2 - BACKGROUND: Chronic lung allograft rejection manifested by sustained declines in lung function is the most common cause of late death after lung transplantation. Numerous strategies have shown variable results. We sought to evaluate the effect of FK506 (tacrolimus) on bronchiolitis obliterans syndrome (BOS) after lung transplantation. METHODS: A single-center open study was conducted of 15 patients whose treatment was converted to tacrolimus from cyclosporine. Of the 15, 12 patients had BOS characterized by sustained loses in lung function while receiving cyclosporine. Rate of decline of forced expiratory volume in 1 second (FEV1) for the 12 patients was calculated before and after administration of tacrolimus. Biochemical changes before and after conversion were compared for the entire group. RESULTS: Median monthly rate of decline in FEV1 was significantly reduced after administration of tacrolimus (5.3% vs 1.1%; p = 0.002). Forced vital capacity did not change significantly. No subjects experienced at least a 10% improvement in FEV1. At least a 10% further decline in FEV1 was noted in five subjects, and seven subjects had no change (i.e., within 10% of baseline). A minor nonsignificant increase in creatinine occurred after administration of tacrolimus. Blood cell count, electrolytes, and liver enzymes remained unchanged. The median change in fasting blood glucose was +0.7 mmol/L (p = 0.02). CONCLUSION: Although tacrolimus does not reverse changes in FEV1 with BOS, in this nonrandomized study it seemed to be associated with a decrease in the rate of decline in lung function and no significant sustained toxicity. Further studies are necessary to substantiate this observation. SN - 1053-2498 UR - https://www.unboundmedicine.com/medline/citation/9322139/Tacrolimus_as_rescue_therapy_for_bronchiolitis_obliterans_syndrome_ L2 - https://ClinicalTrials.gov/search/term=9322139 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -