Early experience with sirolimus in lung transplant recipients with chronic allograft rejection

Cahill, Barbara C.; Somerville, K.T.; Crompton, Jason A.; Parker, Seymour; O'Rourke, Mary Kay; Stringham, James C.; Karwande, Shreekanth V.

doi:10.1016/s1053-2498(02)00550-8

Cited by 57 publications

(31 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Intensified immunosuppression with total lymphoid irradiation (TLI) [173,174] or extracorporeal photopheresis (ECPP) [175,176] suggest that these interventions may have a significant, beneficial impact on lung function decline due to BOS, but these interventions can have significant adverse effects and may be associated with significant economic issues, and additional clinical research is required to establish the efficacy of these interventions. Single-centre studies have suggested that other immunosuppressive therapies, such as sirolimus [177], alemtuzumab [178,179] or anti-thymocyte globulin [180], may play a role in the prevention or management of BOS, but additional research is required to evaluate the utility of TLI, ECPP or other changes in chronic maintenance immunosuppression by using alternative immunosuppressive agents (e.g. the mTOR inhibitor, everolimus) to prevent or manage BOS.…”

Section: Key Unanswered Questions and Specific Research Needsmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

View full text Add to dashboard Cite

Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS.A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations.The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS.The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention. Executive summaryMany lung transplant recipients develop delayed allograft dysfunction that has been traditionally referred to as bronchiolitis obliterans syndrome (BOS), which is thought to be caused by inflammation, destruction and fibrosis of small airways in the lung allograft that leads to obliterative bronchiolitis (OB). Because a definitive diagnosis of OB is difficult to make without a surgical lung biopsy, a decrease in the forced expiratory volume in 1 s (FEV1) has been used as a surrogate marker to identify patients who develop a syndrome of significant and persistent loss of lung allograft function with onset three or more months following transplantation. However, it is now recognised that numerous factors apart from OB can lead to a delayed onset, significant decline in lung function, and these causes of delayed onset graft dysfunction must be carefully excluded when a diagnosis of BOS is made. In general, BOS responds poorly to therapeutic interventions but may stabilise, and some patients may have a significant improvement in FEV1 with certain ther...

show abstract

Section: Key Unanswered Questions and Specific Research Needsmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

View full text Add to dashboard Cite

show abstract

“…15,16 Reports also have suggested a benefit for patients with BOS. 6,7 However, a lack of information exists regarding the appropriate dosing and drug target concentrations when both drugs are used in combination.…”

mentioning

confidence: 99%

Successful use in lung transplantation of an immunosuppressive regimen aimed at reducing target blood levels of sirolimus and tacrolimus

Villanueva

Boukhamseen

Bhorade

2005

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

“…6,7 Sirolimus is a potent new immunosuppressant and previous studies have shown its effects on inhibition of T-cell responses, as well as an effect against graft chronic rejection. 17,18 Sirolimus plus cyclosporine has been shown to have improved impact on prevention of acute rejection, and longer term on the prevention of cardiac allograft vasculopathy. 19 However, its influence on the function of antigen-presenting cells (APC) has not been studied extensively.…”

Section: Discussionmentioning

confidence: 99%

Mechanistic Insights Into Achievement of Cardiac Allograft Long-term Survival by Treatment With Immature Dendritic Cells and Sub-dose Sirolimus

Tao

Wang

Chen

et al. 2006

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Early experience with sirolimus in lung transplant recipients with chronic allograft rejection

Cited by 57 publications

References 24 publications

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

Successful use in lung transplantation of an immunosuppressive regimen aimed at reducing target blood levels of sirolimus and tacrolimus

Mechanistic Insights Into Achievement of Cardiac Allograft Long-term Survival by Treatment With Immature Dendritic Cells and Sub-dose Sirolimus

Contact Info

Product

Resources

About