Inhaler ups survival in lung-transplant recipients

Conventional immunosuppressive drugs do not prevent long-term rejection after lung transplantation, lead author Dr. Aldo T. Iacono, from the University of Maryland in Baltimore, and colleagues note. Delivery of cyclosporine directly to the lung transplant, through the use of an inhaler, may help cut the rates of both early and long-term rejection.

To investigate, the researchers assessed the outcomes of 58 lung transplant recipients who were randomly assigned to use a cyclosporine or inactive "placebo" inhaler for three days a week for the first two years following transplantation.

As noted, no significant difference was seen between the groups in the rate of early rejection. In each group, about 0.45 rejection episodes occurred per patient per year.

Fourteen patients in the placebo group died compared with just three in the cyclosporine group, a reduction in risk of 80 percent. Long-term rejection-free survival was also better in the cyclosporine group with 6 rejection events noted compared with 19 in the placebo group.

The cyclosporine and placebo groups had similar rates of kidney side effects and infections related to their suppressed immune system, the report indicates.

"Further experience with inhaled cyclosporine is needed to confirm the magnitude and durability of the observed effects in recipients of single-lung and double-lung transplants," the researchers add.

Dr. Malcolm M. DeCamp, from Beth Israel Deaconess Medical Center in Boston, agrees that more studies are needed and notes that research in this field is often lacking.

"These results should be received enthusiastically by lung-transplant physicians and surgeons but need to be confirmed in a more broadly inclusive multicenter trial. Such trials have been woefully lacking in the lung-transplantation world, in which 78 percent of centers perform fewer than 20 transplantations per year," he comments in a related editorial.

SOURCE: The New England Journal of Medicine, January 12, 2006.