Brief communicationAirway anastomosis complications in de novo lung transplantation with sirolimus-based immunosuppression☆
Section snippets
Methods
In this prospective, pilot trial we studied the efficacy of the immunosuppressive combination of sirolimus, tacrolimus and corticosteroids in the prevention of acute and chronic rejection after primary lung transplantation before starting a randomized trial comparing this new regimen with our standard protocol consisting of tacrolimus, mycophenolate mofetil and corticosteroids.
All patients having undergone lung transplantation between July and September 2002 were included. Re-transplantations
Results
After enrollment of 4 patients we temporarily stopped the study due to severe adverse events suspected to be related to the use of sirolimus. Therefore, we report our preliminary results as individual case reports.
Discussion
Healing of bronchial anastomosis has been a major problem in lung transplantation.6 The main risk factors identified in the past were surgical technique, high-steroid–based immunosuppressive therapy, bronchial ischemia, acute rejection and acute fungal and bacterial infection.
The donor bronchus receives its blood supply post-operatively via low-pressure, retrograde perfusion from pulmonary artery collaterals and, consequently, is at significant risk of ischemia until neo-vascularization occurs,
Acknowledgements
The authors thank the entire transplant group without whom the transplant program would not be possible: Dept. of Cardiac Surgery: Eckart Kreuzer, Markus Mueller, Ingo Kacrzmarek, Peter Landwehr, Bruno Reichart, Heike Mellmann, Christina Raps; Dept. of General Surgery: Tim Strauss, Reinhard Kopp, Christian Mueller, Rolf Weidenhagen, Hauke Winter, Gerhard Preißler, Karl-Walter Jauch; Dept. of Anesthesia: Michael Irlbeck, Marion Weis, Florian Demetz, Barbara Korpol; Dept. of Internal Medicine:
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Supported by a grant from Wyeth-Pharma GmbH, Muenster, Germany, and Fujisawa GmbH, Munich, Germany.