Pharmacodynamics of cyclosporine in heart and heart-lung transplant recipients .2. Blood cyclosporine concentrations and other risk factors for lung allograft rejection

被引:7
作者
Best, NG
Tan, KKC
Trull, AK
Spiegelhalter, DJ
Stewart, S
Wallwork, J
机构
[1] MRC,INST PUBL HLTH,BIOSTAT UNIT,CAMBRIDGE,ENGLAND
[2] ADDENBROOKES HOSP,CLIN PHARMACOL UNIT,CAMBRIDGE,ENGLAND
[3] ADDENBROOKES HOSP,DEPT CLIN BIOCHEM,CAMBRIDGE,ENGLAND
[4] PAPWORTH HOSP,DEPT HISTOPATHOL,CAMBRIDGE,ENGLAND
[5] PAPWORTH HOSP,TRANSPLANT UNIT,CAMBRIDGE,ENGLAND
关键词
D O I
10.1097/00007890-199611270-00010
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
We have attempted to quantify the optimal clinical use of cyclosporine during the first 3 months after heart-lung transplantation. We used multiple logistic regression to investigate the influence of blood cyclosporine concentrations and other potential risk factors on histologically confirmed acute lung rejection in 50 heart-lung transplant recipients. A 50% increase in cyclosporine concentration was associated with a 25% reduction in risk of rejection in the subsequent 5 days (P=0.008). Increasing oral corticosteroid dose also protected against rejection (P=0.006). Rejection was over 4 times more likely to occur during the first 20 postoperative days (P=0.002). After 20 days, an FEV(1) less than or equal to 70% of the age-, sex-, and height-adjusted expected score was associated with a 4-fold increase in risk of rejection (P=0.01), Patients who had multiple previous rejection episodes were also predisposed to further rejection (P=0.005). An investigation of threshold levels for the cyclosporine concentration-effect relationship suggested that cyclosporine concentrations above 500 mu g L(-1) provide optimal protection against acute lung allograft rejection, This result provides an objectively defined therapeutic threshold for targeting early cyclosporine concentrations following heart-lung transplantation.
引用
收藏
页码:1436 / 1441
页数:6
相关论文
共 19 条
  • [1] Pharmacodynamics of cyclosporine in heart and heart-lung transplant recipients .1. Blood cyclosporine concentrations and other risk factors for cardiac allograft rejection
    Best, NG
    Trull, AK
    Tan, KKC
    Spiegelhalter, DJ
    Cary, N
    Wallwork, J
    [J]. TRANSPLANTATION, 1996, 62 (10) : 1429 - 1435
  • [2] BLOOD CYCLOSPORINE CONCENTRATIONS AND THE SHORT-TERM RISK OF LUNG REJECTION FOLLOWING HEART-LUNG TRANSPLANTATION
    BEST, NG
    TRULL, AK
    TAN, KKC
    HUE, KL
    SPIEGELHALTER, DJ
    GORE, SM
    WALLWORK, J
    [J]. BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 1992, 34 (06) : 513 - 520
  • [3] FESTENSTEIN H, 1989, TRANSPLANT P, V21, P797
  • [4] GRIFFITH BP, 1989, HEART HEART LUNG TRA
  • [5] TRANS-BRONCHIAL LUNG-BIOPSY FOR THE DIAGNOSIS OF REJECTION IN HEART-LUNG TRANSPLANT PATIENTS
    HIGENBOTTAM, T
    STEWART, S
    PENKETH, A
    WALLWORK, J
    [J]. TRANSPLANTATION, 1988, 46 (04) : 532 - 539
  • [6] HOLT DW, 1994, ANN CLIN BIOCH
  • [7] LONGITUDINAL DATA-ANALYSIS USING GENERALIZED LINEAR-MODELS
    LIANG, KY
    ZEGER, SL
    [J]. BIOMETRIKA, 1986, 73 (01) : 13 - 22
  • [8] THE LONG-TERM COURSE OF CYCLOSPORINE-ASSOCIATED CHRONIC NEPHROPATHY
    MYERS, BD
    SIBLEY, R
    NEWTON, L
    TOMLANOVICH, SJ
    BOSHKOS, C
    STINSON, E
    LUETSCHER, JA
    WHITNEY, DJ
    KRASNY, D
    COPLON, NS
    PERLROTH, MG
    [J]. KIDNEY INTERNATIONAL, 1988, 33 (02) : 590 - 600
  • [9] LUNG-FUNCTION ASSOCIATED WITH HISTOLOGICALLY DIAGNOSED ACUTE LUNG REJECTION AND PULMONARY INFECTION IN HEART-LUNG TRANSPLANT PATIENTS
    OTULANA, BA
    HIGENBOTTAM, T
    SCOTT, J
    CLELLAND, C
    IGBOAKA, G
    WALLWORK, J
    [J]. AMERICAN REVIEW OF RESPIRATORY DISEASE, 1990, 142 (02): : 329 - 332
  • [10] THE USE OF HOME SPIROMETRY IN DETECTING ACUTE LUNG REJECTION AND INFECTION FOLLOWING HEART-LUNG TRANSPLANTATION
    OTULANA, BA
    HIGENBOTTAM, T
    FERRARI, L
    SCOTT, J
    IGBOAKA, G
    WALLWORK, J
    [J]. CHEST, 1990, 97 (02) : 353 - 357