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Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans

Divisions of ¹ Pulmonary, Allergy and Critical Care Medicine, ⁵ Cardiothoracic Surgery, and ³ Dept of Pathology, University of Pittsburgh, Pittsburgh, PA, ² Division of Cardiac Surgery, University of Maryland, Baltimore, MD, and ⁴ Division of Pulmonary and Critical Care Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA

CORRESPONDENCE: A.T. Iacono, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, NW 628 Montefiore University Hospital, 3459 Fifth Ave., Pittsburgh, PA 15213, USA. Fax: 1 4126477875. E-mail: iaconoat@msx.upmc.edu

Keywords: aerosol cyclosporin, bronchiolitis obliterans, chronic rejection, lung transplantation, survival

Received: May 26, 2003
Accepted October 8, 2003

This study was supported, in part, by American Lung Association Grant No. CG-013-N.

The majority of patients who develop bronchiolitis obliterans, after lung transplantation, die within 2–3 yrs after onset since treatment with conventional immunosuppression is typically ineffective. A case/control study was conducted in lung transplant recipients with biopsy-documented bronchiolitis obliterans to determine whether aerosol cyclosporin use contributed to increased survival.

The cases comprised 39 transplant recipients who received open-label aerosol cyclosporin treatment in addition to conventional immunosuppression. The controls were transplant recipients treated with conventional immunosuppression alone. There were 51 controls from the University of Pittsburgh Medical Center and 100 from a large multicentric database (Novartis Lung Transplant Database).

Forced expiratory volume in one second expressed as a percentage of the predicted value was an independent predictor of survival in all patients with bronchiolitis obliterans. Cox proportional-hazards analysis revealed a survival advantage for aerosol cyclosporin cases compared to the Pittsburgh control group. A survival advantage was also seen when comparing study cases to multicentric controls.

Aerosol cyclosporin, given with conventional immunosuppression to lung transplant recipients with bronchiolitis obliterans, provides a survival advantage over conventional therapy alone.

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