Article Impact Level: HIGH Data Quality: STRONG Summary of The Journal of Heart and Lung Transplantation, 44(3), 307–317. https://doi.org/10.1016/j.healun.2024.10.013 Dr. Michael P. Combs et al.
Points
- This retrospective cohort study used data from the ISHLT Thoracic Organ Transplant Registry to assess the real-world effectiveness of tacrolimus versus cyclosporine in preventing chronic lung allograft dysfunction (CLAD).
- The study found that cyclosporine use in lung transplant recipients was associated with a higher risk of developing CLAD and a higher risk of death or retransplantation compared to tacrolimus immediate release (IR).
- The hazard ratio for CLAD development and death or retransplantation was 1.16 for cyclosporine compared to tacrolimus IR, suggesting that tacrolimus IR provides better protection against CLAD and improves survival outcomes.
- No significant differences were observed between tacrolimus immediate release and tacrolimus extended release, though the comparison was limited by the small number of patients using tacrolimus XR.
- The study supports the use of tacrolimus immediate release as the preferred maintenance immunosuppressive to reduce the risk of CLAD and improve long-term survival in lung transplant recipients.
Summary
This retrospective cohort study evaluated the real-world effectiveness of tacrolimus versus cyclosporine in preventing chronic lung allograft dysfunction (CLAD) in lung transplant recipients. Using data from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant (TTX) Registry, the study focused on adult lung transplant recipients between January 1, 2000, and June 30, 2018. 22,222 patients were included, with 19,698 receiving tacrolimus immediate release (IR), 2,477 receiving cyclosporine, and 47 receiving tacrolimus extended release (XR). The primary exposure variable was the calcineurin inhibitor (CNI) regimen at post-transplant discharge, and the primary outcomes were time to CLAD development and allograft survival, with death or retransplantation considered a competing risk.
The study found that cyclosporine use as a maintenance immunosuppressive was associated with a higher risk of developing CLAD compared to tacrolimus IR. Specifically, the hazard ratio (HR) for CLAD development with cyclosporine was 1.16 (95% CI, 1.08–1.23, p < 0.001), and the HR for overall death or retransplantation was also 1.16 (95% CI, 1.09–1.23, p < 0.001). No significant differences were found between tacrolimus IR and tacrolimus XR, although this comparison was limited by the small number of patients using tacrolimus XR.
In conclusion, the study supports the hypothesis that tacrolimus IR is associated with better long-term outcomes than cyclosporine in lung transplant recipients, with a lower incidence of CLAD and improved allograft survival. This finding emphasizes the importance of tacrolimus IR in clinical practice for lung transplant recipients, particularly in preventing CLAD and improving overall survival outcomes.
Link to the article: https://www.jhltonline.org/article/S1053-2498(24)01902-8/abstract
References Combs, M. P., Walter, K., Hixson, H., Belloli, E. A., Najor, M. S., Chan, K. M., Chang, A. C., & Lyu, D. M. (2025). Impact of tacrolimus vs cyclosporine on chronic lung allograft dysfunction incidence and allograft survival in the International Society of Heart and Lung Transplantation registry. The Journal of Heart and Lung Transplantation, 44(3), 307–317. https://doi.org/10.1016/j.healun.2024.10.013
