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Early outcomes in human lung transplantation with Thymoglobulin or Campath-1H for recipient pretreatment followed by posttransplant tacrolimus near-monotherapy

McCurry, KR and Iacono, A and Zeevi, A and Yousem, S and Girnita, A and Husain, S and Zaldonis, D and Johnson, B and Hattler, BG and Starzl, TE (2005) Early outcomes in human lung transplantation with Thymoglobulin or Campath-1H for recipient pretreatment followed by posttransplant tacrolimus near-monotherapy. Journal of Thoracic and Cardiovascular Surgery, 130 (2). 528 - 537. ISSN 0022-5223

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Abstract

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. Copyright © 2005 by The American Association for Thoracic Surgery.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
McCurry, KR
Iacono, A
Zeevi, A
Yousem, Syousem@pitt.eduYOUSEM
Girnita, A
Husain, S
Zaldonis, D
Johnson, B
Hattler, BG
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 August 2005
Date Type: Publication
Journal or Publication Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 130
Number: 2
Page Range: 528 - 537
DOI or Unique Handle: 10.1016/j.jtcvs.2004.09.040
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0022-5223
Other ID: uls-drl:31735062121110, Starzl CV No. 2201
Date Deposited: 08 Apr 2010 17:37
Last Modified: 13 Oct 2017 21:57
URI: http://d-scholarship.pitt.edu/id/eprint/5587

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