Session Name: Lung: All Topics
Session Date & Time: None. Available on demand.
*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 September 16, 2021.
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