Abstract
Introduction
Baseline immunosuppression at Leuven University Hospital changed from CsA-AZA to FK506-MPA in March 2011. This study investigates early post-operative outcomes in a cohort 1 year before and 1 year after the conversion of immunosuppression.
Methods
Cohort 1 (LTx between 03/2010 - 03/2011, n= 58) was initially treated with CsA-AZA and cohort 2 (LTx between 03/2011 - 03/2012, n=65) with FK506-MPA, together with steroids and rATG for 3 days. Exclusion criteria were retransplantation (CsA-AZA n=3, FK506-MPA n=7) and death <6 months post-LTx(CsA-AZA n=3, FK506-MPA n=3). Outcome parameters included acute rejection (AR), lymphocytic bronchiolitis (LB), respiratory infection, need for antirejection therapy, BAL cell profile and FEV1.
Results
The FK506-MPA cohort demonstrated significantly more LB at 1 month (p=0.029) and 6 months (p=0.031), whereas CsA-AZA patients experienced more AR at 3 months (p=0.048) and needed more episodes of antirejection therapy (steroids) within the first 3 months (p=0.0002) following LTx. BAL neutrophilia was persistently, although not significantly, higher in FK506-MPA. Infection rates and FEV1%pred were comparable between both cohorts.
Discussion
FK506-MPA as initial immunosuppressive treatment results in less early AR and early anti-rejection therapy, but more early LB and BAL neutrophilia. The possible effect on development of CLAD and survival remains to be awaited.
- © 2013 ERS
