DOSE STUDY OF THE IMMUNOSUPPRESSION OF FK-506 IN CANINE LUNG ALLOTRANSPLANTATION

The immunosuppressive effect of FK506 (FK) in comparison to cyclosporine A (CsA) on lung graft rejection was demonstrated using 24 mongrel dogs with left lung allotransplanatation. The cytotoxic activity of peripheral blood mononuclear cells was evaluated using donor skin fibroblasts. In eight dogs not given immunosuppression, the grafted lungs lost aeration 5-10 days postoperatively, and histologic findings revealed grade 11 rejection and cytotoxic activity elevated to between 10.7 and 60.5%, being an average of 31.2% at an effector/target (E/T) ratio of 50. Of 12 dogs treated with FK, none demonstrated a cytotoxic activity of 10% or more at an E/T ratio of 50. Moreover, histologic examinations of the specimens obtained by open chest biopsy revealed no signs of rejection during the first 10 postoperative days of FK administration, except in one dog showing grade I rejection from the FK 0.05 mg/kg group. A dose study of the duration until the onset of graft rejection and the elevation of cytotoxic activity after the termination of FK administration revealed approximately 1-2 weeks in the FK 0.05 mg/kg group, 3-4 weeks in the 0.1 mg/kg group, and later in the 0.4 mg/kg and 2.0 mg/kg groups. However, severe body weight loss was seen in the 0.4 mg/kg and 2.0 mg/kg groups postoperatively, without recovery even after the termination of FK. In fact, two dogs died of pneumonia possibly derived from general emaciation. These results suggest the optimal concentration of FK in canine lung allo-transplantation to be 0.1 mg/kg intramuscularly.