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Bivalirudin and argatroban were similar in achieving and maintaining therapeutic anticoagulation goals, clinical outcomes, and safety. This study suggests that bivalirudin represents an alternative in the management of HIT, but prospective studies are needed.

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ABSTRACT:Lung transplant immunosuppression regimens generally include the calcineurin inhibitor tacrolimus. We hypothesized that mean residual expression (MRE) of calcineurin-dependent genes assesses rejection and infection risk better than tacrolimus trough. We prospectively followed 44 lung allograft recipients 2 to 18 months post-transplant and measured changes in whole blood IL-2, interferon-, and GM-CSF gene expression following a tacrolimus dose. Posttransplant duration, immunosuppressive medication levels, and bronchoscopic rejection and infection assessments were compared with MRE using generalized-estimating equationadjusted models. Prednisolone effect on MRE was assessed ex vivo in blood samples from non-transplanted controls. Tacrolimus concentration inhibiting 50% of cytokine production (IC50) was measured in a pre-transplant subset. Results showed that MRE did not change with diagnosis of rejection, but that airway infection was associated with a 20% absolute decrease (95% CI 11% -29%). MRE increased with time following transplantation but was not associated with tacrolimus trough. Interestingly, MRE correlated inversely with corticosteroid dose in the study cohort and ex vivo. Pre-transplant tacrolimus IC50 depended on the cytokine measured and varied between individuals, suggesting a range in baseline responses to tacrolimus. We conclude that MRE identifies infection risk in lung allograft recipients, potentially integrating calcineurin inhibitor and steroid effects on lymphocyte effector function. INTRODUCTION:

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