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Cited by 160Transplantation: Methods and OutcomesRenal Transplantation Outcomes and TreatmentsOrgan and Tissue Transplantation Research

A Randomized Controlled Trial of Tacrolimus Versus Cyclosporine After Lung Transplantation

Hachem, Ramsey R., Yusen, Roger D., Chakinala, Murali M., Meyers, Bryan F., Lynch, John P., Aloush, Aviva A., Patterson, G. Alexander, Trulock, Elbert P.·2007·The Journal of Heart and Lung Transplantation
DOI 10.1016/j.healun.2007.07.027
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Abstract

Background The optimal maintenance immunosuppressive regimen after lung transplantation is uncertain. Methods We conducted a randomized controlled trial of tacrolimus versus cyclosporine in combination with azathioprine and prednisone after lung transplantation. Ninety adults were randomized to tacrolimus (n = 44) or cyclosporine (n = 46). The primary end point was a composite of a cumulative acute rejection A score of 3 or higher, a cumulative lymphocytic bronchitis B score of 4 or higher, or the onset of bronchiolitis obliterans syndrome (BOS) stage 0-p. Results Recipients randomized to cyclosporine were significantly more likely to develop the primary end point than those randomized to tacrolimus. During the study period, the primary end point developed in 39 of 46 cyclosporine subjects compared with 24 of 44 tacrolimus subjects (p = 0.002); acute rejection or lymphocytic bronchitis end points developed in 29 of 46 cyclosporine subjects compared with 18 of 44 tacrolimus subjects (p = 0.036). Furthermore, BOS stage 0-p was more likely to develop in the cyclosporine group than in the tacrolimus group, but this was not statistically significant (log-rank p = 0.1). In addition, there was a trend to a higher incidence of diabetes among those in the tacrolimus group, but there was no significant difference in graft survival or the total number of infections, or in the incidence of hypertension, chronic kidney disease, or cancer between the 2 groups. Conclusions Tacrolimus is associated with a lower burden of acute rejection and lymphocytic bronchitis and a trend to a greater freedom from BOS stage 0-p than cyclosporine after lung transplantation.

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Crossref · 10.1016/j.healun.2007.07.027

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  • Cyclosporine-based immunosuppressive regimens have been shown to be inferior to tacrolimus-based therapy, with higher rates of acute cellular rejection and increased CLAD incidence.

    “This finding is plausible, as cyclosporine-based immunosuppressive regimens have been shown to be inferior to tacrolimus-based therapy, with higher rates of acute cellular rejection and increased CLAD incidence.16, 17, 18, 19, 20”

    From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [18]

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Authors
Hachem, R. R., Yusen, R. D., Chakinala, M. M., Meyers, B. F., Lynch, J. P., Aloush, A. A., Patterson, G. A., & Trulock, E. P.
Affiliations
Washington University in St. Louis (US)
ORCID
Venue
The Journal of Heart and Lung Transplantation
Publisher
Elsevier BV
Published
2007-10
Volume
26
Issue
10
Pages
1012-1018
ISSN
1053-2498 (ISSN-L)
DOI
10.1016/j.healun.2007.07.027
OpenAlex
W2082707670
Cited by
160
References
27
Citations by year
2026: 8 · 2025: 7 · 2024: 8 · 2023: 18 · 2022: 8 · 2021: 9 · 2020: 8 · 2019: 3 · 2018: 12 · 2017: 6 · 2016: 6 · 2015: 2 · 2014: 9 · 2013: 7 · 2012: 6
FWCI
10.63
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Journal of Heart and Lung Transplantation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
Keywords
tacrolimus, cyclosporine, lung transplantation, maintenance immunosuppression, acute rejection, bronchiolitis obliterans syndrome, azathioprine, prednisone, diabetes mellitus, graft survival
MeSH terms
Adult, Azathioprine, Bronchiolitis Obliterans, Bronchitis, Diabetes Mellitus, Drug Therapy, Combination, Female, Graft Rejection, Graft Survival, Humans, Immunosuppressive Agents, Male, Middle Aged, Postoperative Care, Lung Transplantation, Tacrolimus, Cyclosporine

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