Airway anastomosis complications in de novo lung transplantation with sirolimus-based immunosuppression

J Heart Lung Transplant. 2004 May;23(5):632-8. doi: 10.1016/S1053-2498(03)00309-7.

Abstract

A prospective, pilot trial was started to evaluate the effect of a sirolimus-based immunosuppressive regimen on acute and chronic rejection in de novo lung transplant patients. Primary lung transplant (LTx) recipients received a sirolimus- and tacrolimus-based immunosuppressive therapy immediately after transplantation. Both immunosuppressants were administered with trough level adjusted, while steroid administration was minimized. Four patients were enrolled (2 single-lung transplants, 1 double-lung transplant, 1 heart-lung transplant) in the study. Mean ischemia time was 387 +/- 92 minutes. Acute rejection (at least Grade A1 ISHLT) was detected in 1 patient. Incidence of infection was 0.6 infection per 100 patient-days (3 Aspergillus infections). Until hospital discharge mean sirolimus trough level was 6.2 +/- 1.2 ng/ml. Depending upon mean sirolimus trough levels of each patient, severe wound-healing complications were seen in 3 patients, resulting in bronchial airway dehiscence in 2 patients with lethal outcome in 1 patient. As a result of these complications, we revised the study design after inclusion of only 4 patients: Sirolimus administration is now started after completion of bronchial wound-healing. Sirolimus-based immunosuppressive therapy administered immediately after lung transplantation seems to be associated with severe wound-healing complications of the bronchial anastomosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Bronchial Diseases / etiology*
  • Graft Rejection / prevention & control
  • Heart-Lung Transplantation
  • Humans
  • Immunosuppression / adverse effects*
  • Immunosuppression / methods*
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Pilot Projects
  • Postoperative Complications
  • Prospective Studies
  • Sirolimus / administration & dosage*
  • Sirolimus / adverse effects
  • Tacrolimus / administration & dosage
  • Wound Healing / drug effects

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Sirolimus
  • Tacrolimus