Mycophenolate mofetil reduces alveolar inflammation, acute rejection and graft loss due to bronchiolitis obliterans syndrome after lung transplantation.

Abstract

BACKGROUND:

Bronchiolitis obliterans syndrome (BOS) is still the main complication after lung transplantation. Besides other improvements in post-operative management, newer immunosuppressive regimens might decrease the devastating sequelae of this complication.

METHODS:

We compared the prospectively collected data of lung transplant recipients treated either with azathioprine (AZA; n = 48) or mycophenolate mofetil (MMF; n = 108), who underwent regular monthly surveillance bronchoscopies for at least 6 post-operative months.

RESULTS:

Patients on MMF had significantly fewer acute (P < 0.001) and recurrent (P < 0.001), as well as less severe rejection episodes (P = 0.01). In addition, MMF significantly reduced the number of alveolar lymphocytes, eosinophils and neutrophils (P < 0.001), and decreased the hemosiderin score reflecting non-specific alveolar-capillary damage (P < 0.001). Although there was no change in the three stages of BOS, there was a trend towards improved survival (P = 0.062) and a significant decrease in graft loss due to BOS (P = 0.049) in patients receiving MMF.

CONCLUSIONS:

Immunosuppression with MMF significantly decreased the incidence, severity and recurrence of acute rejection episodes in lung transplant recipients. Parameters of alveolar inflammation and alveolar-capillary damage were also decreased. As a potential consequence, MMF significantly reduced graft loss due to BOS and tended to improve overall survival in these patients.

• Authors: Rudolf Speich, Silvia Schneider, Markus Hofer, Sarosh Irani, Peter Vogt, Walter Weder, Annette Boehler
• Journal: Pulmonary pharmacology & therapeutics (Pulm Pharmacol Ther) Vol. 23 Issue 5 Pg. 445-9 (Oct 2010) ISSN: 1522-9629 [Electronic] England
• PMID: 20394831 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright 2010 Elsevier Ltd. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Mycophenolic Acid
• Azathioprine

Topics

• Adult
• Azathioprine (therapeutic use)
• Bronchiolitis Obliterans (etiology, prevention & control)
• Bronchoalveolar Lavage Fluid (cytology, immunology)
• Female
• Graft Rejection (prevention & control)
• Graft Survival
• Humans
• Immunosuppressive Agents (therapeutic use)
• Inflammation (immunology, prevention & control)
• Lung Transplantation (adverse effects, immunology)
• Macrophages, Alveolar (drug effects, immunology)
• Male
• Middle Aged
• Mycophenolic Acid (analogs & derivatives, therapeutic use)
• Prospective Studies
• Pulmonary Alveoli (drug effects, immunology)
• Treatment Outcome