BACKGROUND: The need for better immunosuppressive protocols after lung transplantation led us to investigate tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and steroids or cyclosporine (CsA) in combination with MMF and steroids in a prospective, open, randomized trial after lung transplantation. METHODS: Between September 1997 and April 1999, 50 lung transplant recipients were randomized to receive either Tac (n = 26) or CsA (n = 24) in combination with MMF and steroids. All patients underwent induction therapy with rabbit antithymocyte globulin (ATG) for 3 days. Freedom from acute rejection (AR), patient survival, infection episodes, and side effects were monitored. RESULTS: There was no difference in patient demographics between the two groups. Six-month and 1-year survival was similar (84.6% and 73.1% in the Tac group vs 83.3% and 79.2% in the CsA group). Freedom from AR at 6 months and 1 year after lung transplantation was slightly higher in the Tac group (57.7% and 50% vs 45.8% and 33.3%, p = not significant [n.s.]), whereas the number of treated rejection episodes per 100 patient days in the Tac group was significantly lower (0.225 vs 0.426, p < .05). Four patients in the CsA group had to be switched to Tac. Two patients in the CsA group had to be retransplanted. Incidence of infections was similar in both groups with a trend toward more fungal infections in the Tac group (n = 7 vs n = 1, p = n.s.). CONCLUSIONS: The combination of Tac and MMF seems to have slightly higher immunosuppressive potential compared with CsA and MMF. The effectiveness of Tac as a rescue agent is not paralleled with undue signs of overimmunosuppression.

Acute Disease↗

PubMed2000

Lung transplantation today.

Lung transplantation has become an accepted surgical modality, and it is indicated in patients with a long-term benign pulmonary disease in stage when all the other therapeutic possibilities failed. Nowadays it presents a real possibility to significantly improve the quality of life. Success, (mainly in the last decade), establishing international professional centers, national coordinations, shifts transplantation towards the standard treatment procedures. The objective of the paper is to offer an overview of the international activities, trends and results in the area of lung transplantation. Authors present a review of the current situation based on their own experiences gained from the bilateral cooperation with Vienna Transplant Group. (Tab. 4, Fig. 4, Ref. 19.)

Humans↗

PubMed1999

Bilateral lobar transplantation with the split lung technique.

Explore the source record for details and available documents.

Adolescent↗

PubMed1999

Comparison between mycophenolate mofetil- and azathioprine-based immunosuppressions in clinical lung transplantation.

BACKGROUND: The aim of the study was to assess the impact of mycophenolate mofetil (MMF) on the early phase after lung transplantation. PATIENTS AND METHODS: Thirty-eight consecutive patients between November 1994 and January 1997 were treated with cyclosporine, prednisolone, antithymocyte globuline induction therapy, and either MMF (n = 21) or azathioprine (Aza) (n = 17). Four patients from the MMF group and 2 patients from the Aza group were intubated and in the ICU prior to transplantation. Demographic data and primary diagnosis were comparable. MMF was administered at a dosage of 2 gm/day whereas Aza was initiated at 2 mg/kg/day and adapted by leukocyte count. Three-month survival and incidence of rejections and infections were compared. RESULTS: Six-month survival in the MMF group was 76% compared to 65% in the Aza group (n.s.). The mean number of acute rejection episodes in the MMF and Aza group were 0.29+/-0.10 and 1.53+/-0.29 (p<0.01) respectively. Transbronchial biopsy (TBB) results > or =grade 2 ISHLT were seen in 10% of MMF and in 43% of Aza-treated patients; completely free from rejection were 17 MMF and 3 Aza patients. The mean number of infections per patient in the MMF and Aza group were 1.57+/-0.29 and 2.29+/-0.40 respectively, bacterial (1.10 vs. 1.71), viral (0.35 vs. 0.33), and fungal (0.14 vs. 0.24) infections were the same in both groups. CONCLUSIONS: These data result suggest that mycophenolate mofetil therapy is more effective in preventing rejection episodes in patients early after lung transplantation than therapy with azathioprine. We therefore conclude that MMF is a safe and effective drug to optimize immunosuppressive therapy in the early phase after lung transplantation.

Adolescent↗

PubMed1999

Inhalation of nitric oxide as a life-saving therapy in a patient after pulmonary embolectomy.

We describe a 54-yr-old man with cardiogenic shock caused by acute right heart failure after pulmonary embolectomy. Inhalation of nitric oxide led to immediate improvement in respiratory and haemodynamic variables. Inhaled nitric oxide can be used to reduce acute right heart failure until conventional therapy can provide successful haemodynamic stability.

Administration, Inhalation↗

PubMed1998

[Functional results and long-term outcome after bilateral lung transplantation for pulmonary hypertension].

Pulmonary hypertension (PH) signifies elevated blood pressure in the pulmonary circulation either due to clearly defined causes (cardiac, pulmonary-parenchymatous, systemic) or of idiopathic origin (primary PH, PPH). While conservative treatment is beneficial only for a small number of patients, lung transplantation represents a curative measure. The optimal form of transplantation [i.e. single lung (SLTX), bilateral lung (BLTX) or combined heart-lung transplantation (HLTX)] is still under discussion. This study is a retrospective analysis of 16 patients with different forms of PH who underwent BLTX from 1992 to 1996 in Vienna. Four patients had Eisenmenger's disease due to atrial septum defect, 3 had chronic thromboembolic PH and 9 had PPH. BLTX with cardiopulmonary bypass was the standard procedure in all patients. Acute retransplantation had to be performed in 3 patients. Mean pulmonary arterial pressure was reduced from 63 +/- 11 mmHg preoperatively to 23 +/- 5 mmHg on the second day postoperatively (p < 0.0001), while the cardiac index concomitantly improved from 2.1 +/- 0.5 to 3.9 +/- 1.2 l/min/m2 (p < 0.05). Echocardiography proved normalisation of right ventricular wall thickness and end-diastolic diameter within 12 months, while tricuspid insufficiency, present in all patients before transplantation, resolved completely. Perioperatively 4 patients (25%) died due to septic complications (n = 3) or therapy refractory rejection (n = 1). Follow-up of the remaining patients ranged from 6 to 51 months (mean 33 +/- 17). One patient died at 8 months due to fungal sepsis. Eleven patients (68%) are currently alive. Only 2 of them show functional signs of chronic allograft rejection (bronchiolitis obliterans syndrome). All patients are at present in NYHA functional class I or II. In conclusion, BLTX results in complete recovery of right ventricular function and morphology and offers good functional long-term results. Because SLTX correlates with a high incidence of reperfusion edema, and HLTX is seriously limited by the scarcity of donor organs, BLTX should be the method of choice for treating end stage PH.

Adult↗

PubMed1998

Lung transplantation for primary pulmonary hypertension and giant pulmonary artery aneurysm.

We report the case of an 18-year-old patient with a giant pulmonary artery aneurysm and primary pulmonary hypertension who was successfully treated with bilateral lung transplantation and complete reconstruction of the pulmonary artery.

Adolescent↗

PubMed1998

Human endothelial cells do not exert heparin like accelerating effects on thrombin-antithrombin-complex formation.

In the present study the formation of thrombin-antithrombin-complexes (TAT) during incubation of thrombin (0.89, 4.5, 8.9 nmol/l) and antithrombin (4.6 micromol/l) on the surface of cultured human EC, derived from different parts of the circulation, and on the surface of human vessel segments was studied. In the absence of EC TAT increased over time reaching a maximum at 60 sec; 10 sec (8.9 nmol/l thrombin): 6.35+/-0.72 nmol/l, 60 sec: 10.49+/-1.04 nmol/l. In the presence of exogenous heparin (0.1 IU/ml) maximum TAT levels were already reached after 10 sec (10.75+/-0.97); cultured EC and EC on vessel segments did not show such heparin effects. Incubation of EC with heparin resulted in an EC-surface localized heparin activity only when very high doses (3.0 IU/ml) of the drug were used. When thrombin was incubated on the EC surface in the presence of AT the efficiency of the thrombomodulin(TM)-protein C(PC)-system was markedly reduced, while in the presence of exogenous heparin (0.5 IU/l) the activity of this pathway was nearly abolished. Our results demonstrate that 1) human EC do not exert heparin-like accelerating effects on TAT formation, 2) an EC localized heparin activity is only generated when EC are incubated with amounts clearly exceeding therapeutical doses, and 3) an acceleration of TAT formation at the EC surface by heparin causes a switching off of the TM-PC-system.

Anticoagulants↗

PubMed1998