RT Journal Article
SR Electronic
T1 Aerosolized liposomal cyclosporine A for treatment of progressive allograft dysfunction following lung transplantation
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2679
VO 42
IS Suppl 57
A1 Franziska Ihle
A1 Matthias Griese
A1 Werner von Wulffen
A1 Rudolf Hatz
A1 Jürgen Behr
A1 Claus Neurohr
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P2679.abstract
AB Aim: The aim of this study was to evaluate aerosolized liposomal cyclosporine a (LCsA) in lung transplant recipients (LTR) with progressive chronic lung allograft dysfunction (CLAD) after failure of conventional therapy (pulsed steroids, azithromycine, montelucast, extracorporeal photophoresis).Methods: Descriptive data analysis was performed prospectively based on lung function testing.Results: 6 LTR (age 38±11.8 years; 3 male; 4 DLTx; 2 HLTx; 5.7±5.1 years after Tx, BOS 1 n=1; BOS 2 n=1; BOS 3 n=4) received LCsA 10mg twice daily p.i. for 50 days (4-365d) as add-on therapy to tacolimus, mycophenolate mofetil and steroids. Two patients inhaled < one week due to re-Tx and cough/nausea and were excluded from analysis. Of the remaining 4 patients baseline FEV1, FVC and TLC were 1.11±0.21l (34±14%pred.), 1.8±0.4l (51±26%pred.) and 4.53±0.8l (76±19%pred.). Interims analysis after 43±29 days revealed a FEV1 of 1.1±0.5l (34±13%pred.), a FVC of 1.75±0.85l (50±21%pred.) and a TLC of 4.35±0.5l (72±22%pred.) and after 107±122 days a FEV1 of 0.81±0.32l (31±14%pred.), a FVC of 1.52±0.68l (47±25%pred.) and a TLC of 4.26±0.67l (74±25%pred.). Laboratory evaluations showed no systemic LCsA concentration (<30ng/ml), no significant change of creatinine levels and no positive CMV-PCR. One patient died (219d), one patient was re-transplanted (43d) and one patient stopped due to pulmonary infections (57d).Conclusion: This case series of selected, treatment-resistant CLAD patients suggest that the use of LCsA in LTR is safe. The therapeutic potential of LCsA in LTR with CLAD should be investigated in future controlled trials.eFlow® device and LCsA was provided by PARI Pharma GmbH.