A randomized trial of tacrolimus (FK506) versus total lymphoid irradiation for the control of repetitive rejection after cardiac transplantation

Keogh, Anne; Arnold, Ruth; Macdonald, P.; Hawkins, Richard C; Morgan, Graeme; Spratt, Phillip

doi:10.1016/s1053-2498(01)00329-1

Cited by 15 publications

(16 citation statements)

References 4 publications

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“…The TLI group grade 3A rejections (moderate rejection, some myocardial damage evident) went from 3.4 to 0.1 after treatment while the grade 1B (mild rejection, interstitial infiltration of lymphocytes) or lower rejections increased from 49% to 97%. A similar result was seen with the Tacrolimus group grade 3A rejection decreasing from 3.2 to 0.7 after treatment with grade 1B or lower increasing from 46% to 90% . Keogh et al .…”

Section: Resultssupporting

confidence: 69%

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Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

McKay

Knight

Wright

2014

J of Medical Radiation Sci

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Immunosuppressive drugs used in the management of heart and lung transplants have a large monetary and quality of life cost due to their side effects. Total lymphoid irradiation (TLI) is one method of minimising the need for or replacing post-operative immunosuppressive drugs. A literature review was conducted on electronic databases using defined search terms. The aim was to establish the indications for the use of TLI, its advantages and disadvantages and the weaknesses associated with the methods used in related research. Eight articles were located that focused on TLI usage in combating organ rejection. These studies identified that the use of TLI resulted in a reduction in early rejection. One study reported a drop in rejection episodes from 0.46 to 0.14 episodes per patient per month once the TLI was complete. While the short-term prognosis is excellent, the long-term outlook is less positive with an increased risk of organ rejection and myelodysplasia 3.5 years post-TLI. This review reminds us that radiation therapy (RT) is not exclusively indicated for cancer treatment. While TLI cannot replace immunosuppressive drug therapy, it can offer a treatment option for people that cannot tolerate immunosuppressive drugs, or when conventional anti-rejection treatment is no longer viable. Reported long-term complications suggest that TLI should be used with caution. However, this modality should not be overlooked in cases of chronic rejection. Further research is required to establish the efficacy of RT in the treatment of transplant patients who are unsuitable for drug-based anti-rejection therapies.

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Section: Resultssupporting

confidence: 69%

“…However Tallaj et al . report that long‐term effects of TLI were increased risk of rejection which is a new phenomena that had not been reported previously in studies with long‐term follow up (7–10 years) and therefore requires further investigation.…”

Section: Resultsmentioning

confidence: 91%

Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

McKay

Knight

Wright

2014

J of Medical Radiation Sci

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“…TLI via mantle, para-aortic and inverted Y-field irradiation, delivered in fractions with a total dose of 8 Gy, has been used to induce donor-specific tolerance before transplantation and to treat refractory acute heart, heart-lung or lung rejection [98]. In heart transplant patients, it has even been shown that conversion to Tac or TLI are equipotent strategies for refractory acute rejection [114] and that MTX or TLI are equally effective [115].…”

Section: Other Immunomodulatory Treatmentsmentioning

confidence: 99%

Immunosuppressive therapy after human lung transplantation

Knoop¹,

Haverich²,

Fischer³

2004

European Respiratory Journal

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numbers of lung transplantation (LTx) were performed with or without induction therapy with antilymphocyte antibodies, monoclonal anti-CD3 antibody or anti-interleukin-2-receptor monoclonal antibodies. It remains to be established if induction therapy after LTx is beneficial or deleterious for long-term graft and patient survival.The vast majority of lung transplant recipients receive a triple-drug maintenance regimen including a calcineurin inhibitor, a cell-cycle inhibitor and steroids. Equal proportions receive cyclosporin A (CsA) and tacrolimus (Tac). There is also a trend to prescribe mycophenolate mofetil (MMF) instead of azathioprine (Aza). Steroid withdrawal is uncommon even 5 yrs after transplantation.The superiority of Tac over CsA as a maintenance agent has not been established to date, and the administration of MMF instead of Aza in combination with CsA and steroids did not improve graft or patient survival in a recent international, prospective, randomised, controlled trial.Shift from cyclosporin A to tacrolimus has emerged as the first treatment step of refractory acute rejection followed by high-dose steroids or antilymphocyte agents, total lymphoid irradiation or photopheresis. The treatment of chronic rejection remains deceptive and includes varied strategies such as modification of the maintenance regimen, addition of inhaled immunosuppressants and/or total lymphoid irradiation and photopheresis. Eur Respir J 2004; 23: 159-171.

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“…Its introduction into transplantation medicine has led to a general reduction in acute rejection rates and has improved organ survival. [1][2][3][4] TAC has become an integral component of immunosuppression protocols in renal, heart, and, increasingly, lung transplantation.…”

mentioning

confidence: 99%

Tacrolimus Pharmacokinetics in Lung Transplantation: New Strategies for Monitoring

Ragette

Kamler

Weinreich

et al. 2005

The Journal of Heart and Lung Transplantation

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A randomized trial of tacrolimus (FK506) versus total lymphoid irradiation for the control of repetitive rejection after cardiac transplantation

Cited by 15 publications

References 4 publications

Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

Immunosuppressive therapy after human lung transplantation

Tacrolimus Pharmacokinetics in Lung Transplantation: New Strategies for Monitoring

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