Lung Transplant Outcomes Based on Immunosuppressive Regimen at Discharge: Data from the US Scientific Registry of Transplant Recipients (SRTR)
1University of Illinois at Chicago, College of Pharmacy, Vernon Hills, IL, 2Astellas Pharma, Inc, Northbrook, IL, 3Astellas Pharma Europe BV, Leiden, Netherlands, 4Chronic Disease Research Group, Minneapolis, MN
Meeting: 2021 American Transplant Congress
Abstract number: 1201
Keywords: Graft survival, Immunosuppression, Lung transplantation, Risk factors
Topic: Clinical Science » Lung » Lung: All Topics
Session Information
Session Name: Lung: All Topics
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: There is currently no FDA approved immunosuppressive regimen for lung transplant (Tx) recipients; however, patients routinely receive a calcineurin inhibitor-based regimen. The SRTR database was analyzed to provide real-world evidence of the efficacy and safety of tacrolimus-based immunosuppressive regimens post lung Tx.
*Methods: Adult and pediatric recipients of a primary deceased donor lung Tx between January 1, 1999 and December 31, 2017 were followed for 3 years post Tx based on immunosuppressive regimen at discharge: immediate-release tacrolimus+mycophenolate mofetil (MMF), immediate-release tacrolimus+azathioprine (AZA), cyclosporine (CYA)+MMF, or CYA+AZA. The primary outcome was the composite endpoint of graft failure or death (all cause) at 1 year post Tx. Cox proportional hazard models were used to test for baseline characteristics associated with a greater risk of graft failure or death in adults.
*Results: Data were available for 26,080 lung Tx recipients (25,355 adults; 725 pediatrics). The most common discharge immunosuppressive regimen was immediate-release tacrolimus+MMF in both groups. Post-Tx outcomes are shown in Tables 1 (adults) and 2 (pediatrics). Adult and pediatric lung Tx patients receiving immediate-release tacrolimus+MMF had a cumulative incidence of graft failure or death at 1 year post Tx of <9% (graft survival >91%) and the lowest rejection rates at 3 years, without increased risk of infection or malignancy. Factors associated with a greater risk of graft failure or death in adults receiving immediate-release tacrolimus+MMF included: recipient age ≥65 years, single lung Tx, hospital stay >24 days, BMI <18.5 kg/m2, serum creatinine ≥1.0 mg/dL, donor age ≥55 years and donor race (Black). Factors associated with a lower risk of graft failure or death included: age at Tx 35-49 years, recipient race (Black), post-Tx hospital stay ≤14 days and CMV-negative donors. The risk of graft failure or death was significantly greater in adults receiving CYA+MMF or CYA+AZA compared with immediate-release tacrolimus+MMF.
*Conclusions: Use of immediate-release tacrolimus+MMF as the discharge immunosuppressive regimen in lung transplant recipients increased substantially from 1999-2017, and was associated with higher 1-year graft survival and numerically lower rates of rejection at 3 years versus CYA+MMF and CYA+AZA.
To cite this abstract in AMA style:
Fitzsimmons W, Erdman J, Wolfram J, Nimke D, Croy R, Wang X, Weaver T, Schladt D. Lung Transplant Outcomes Based on Immunosuppressive Regimen at Discharge: Data from the US Scientific Registry of Transplant Recipients (SRTR) [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/lung-transplant-outcomes-based-on-immunosuppressive-regimen-at-discharge-data-from-the-us-scientific-registry-of-transplant-recipients-srtr/. Accessed May 18, 2025.« Back to 2021 American Transplant Congress