Tacrolimus and Azathioprine Versus Cyclosporine and Mycophenolate Mofetil After Lung Transplantation: A Retrospective Cohort Study

Celik, Muhammet R.; Lederer, David J.; Wilt, Jessie; Eser, Dilek; Bacchetta, Matthew; D'Ovidio, Frank; Sonett, Joshua R.; Arcasoy, Selim M.

doi:10.1016/j.healun.2009.04.010

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 28, Issue 7 , Pages 697-703, July 2009

Tacrolimus and Azathioprine Versus Cyclosporine and Mycophenolate Mofetil After Lung Transplantation: A Retrospective Cohort Study

Muhammet R. Celik, MD
- Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
David J. Lederer, MD, MS
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
Jessie Wilt, MD
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
Dilek Eser, MD
- Hacettepe University School of Medicine, Ankara, Turkey
Matthew Bacchetta, MD
- Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
Frank D'Ovidio, MD, PhD
- Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
Joshua R. Sonett, MD
- Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
Selim M. Arcasoy, MD
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
- Reprint requests: Selim M. Arcasoy, MD, New York Presbyterian Hospital of Columbia and Cornell University, PH 14E, Rm 104, 622 W 168th St, New York, NY, 10032. Telephone: 212-305-6589. Fax: 212-342-5382

Received 10 December 2008; received in revised form 11 March 2009; accepted 7 April 2009. published online 15 May 2009.

Background

The efficacy and safety of different combinations of immunosuppressive regimens after lung transplantation are unknown.

Methods

We examined 120 consecutive transplant recipients between July 2001 and July 2005, of whom 37 received cyclosporine and mycophenolate mofetil (Cyc/MMF) and 83 received tacrolimus and azathioprine (Tac/Aza) as the initial immunosuppressive regimen along with an interleukin-2 antagonist induction therapy. The primary outcome was the rate of histologically confirmed acute rejection.

Results

The rate of acute rejection did not vary by treatment regimen (0.42 vs 0.34 episodes per 100 person-days in Cyc/MMF and Tac/Aza groups, respectively, p = 0.22). The mean cumulative lymphocytic bronchiolitis score was greater in the Cyc/MMF group (1.8 ± 1.9) compared with the Tac/Aza group (1.2 ± 2.0; p = 0.03). Pulmonary function at 1 year was better in the Tac/Aza group, even when adjusted for recipient age, gender, and transplant procedure. Survival and the rate of bronchiolitis obliterans syndrome did not vary by group.

Conclusions

Outcomes after lung transplantation did not meaningfully vary between those assigned to Cyc/MMF compared with Tac/Aza combined with IL-2 inhibitor induction therapy.