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Bartley P. Griffith
Robert L. Hardesty
John M. Armitage
Robert L. Kormos
Gary C. Marrone
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Ann Thorac Surg 1992;54:846-851
© 1992 The Society of Thoracic Surgeons

Articles

Acute rejection of lung allografts with various immunosuppressive protocols

Bartley P. Griffith, MD*, Robert L. Hardesty, MD, John M. Armitage, MD, Robert L. Kormos, MD, Gary C. Marrone, MD, Steve Duncan, MD, Irvin Paradis, MD, James H. Dauber, MD, Samuel A. Yousem, MD, Penny Williams, MD

Department of Surgery, Division of Pulmonary Medicine, Department of Pathology, and Division of Infectious Disease, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

* Address reprint requests to Dr Griffith, Department of Surgery, University of Pittsburgh School of Medicine, 1084 Scaife Hall, Pittsburgh, PA 15261.

Between February 1990 and December 1991, 69 patients who survived for a minimum of 5 days after single-lung (27), double-lung (32), or heart-lung transplantation (10) were studied to learn the incidence and severity of acute rejection and the possible effects of various immunosuppressive protocols on this rejection. Acute rejection was less common (2.1 versus 3.1 episodes/patient) after transplantation in those 30 candidates who received rabbit antithymocyte globulin for the first 5 postoperative days versus the 28 who were maintained on cyclosporine, azathioprine, and prednisone alone (p < 0.05), but no patient escaped at least one episode. Patients given cyclosporine received more 3-day courses of methylprednisolone (p < 0.02) than those given rabbit antithymocyte globulin (2.5 versus 1.7 courses). Although no disadvantage in terms of infectious morbidity was noted in the rabbit antithymocyte globulin group, no obvious intermediate advantage was noted in survival (85% at 12 months) or grade of rejection or airway flows. The most common histopathologic grades were mild (A2) and moderate (A3); the average grade was A2.3. FK 506 was tested in 11 patients, and early results are promising relative to low early and likely fewer late episodes of rejection. No differences were noted in the likelihood of rejection for any procedures.




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