Although the influence of cytochrome P450 inhibitory drugs on the area under the curve (AUC) of cyclosporine (CsA) has been described, data concerning the impact of these substances on the shape of the blood concentration curve are scarce. By assessment of CsA blood levels before and 1, 2, and 4 hr after oral intake (C0, C1, C2, and C4, respectively) CsA profiling examinations were performed in 20 lung transplant recipients taking 400 mg, 200 mg, and no itraconazole, respectively. The three groups showed comparable results for C0, C2, and AUC(0-12). Greater values were found for Cmax, Cmax-C0, peak-trough fluctuation and rise to Cmax in favor of the non-itraconazole group. Additionally, tmax was shorter in the non-itraconazole group. Comedication with the metabolic inhibitor itraconazole is associated with a flattening of the CsA blood concentration profile in lung transplant recipients. These changes cannot be assessed by isolated C0, C2, or AUC(0-12) values alone.
Lung transplantation has become an accepted treatment for end-stage pulmonary parenchymal and vascular diseases. Infections still are the most common cause of early and late morbidity and mortality in lung transplant recipients. Bacterial infections comprise approximately half of all infectious complications. Cytomegalovirus (CMV) infections and disease have become less frequent, because of prophylaxis with ganciclovir. Because CMV is also involved in the pathogenesis of obliterative bronchiolitis, the frequency of this infection may also reduce the occurrence of this main obstacle to successful lung transplantation. Invasive fungal infections remain a problem, but they have also decreased in frequency because of better control of risk factors such as CMV disease and preemptive antifungal therapy. Nonherpes respiratory viral infections have emerged as a serious problem. Their severity may be reduced by treatment with ribavirin. Meticulous postoperative surveillance, however, is still crucial for the management of lung transplant patients with respect to early detection and treatment of rejection and infection.
Background and objective: Individuals with precapillary pulmonary hypertension (PH) experience impaired quality of life (QoL). A disease-specific outcome measure, the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is validated in English. We translated the instrument and validated it for German-speaking population. Methods: A multi-step procedure including bilingual translation process, lay panel assessment, cognitive debriefing interviews, validation and evaluation was performed. It included 107 patients with precapillary PH (60 females; age 60+15 years) from centres in Austria, Germany and Switzerland Results: The translation process was straightforward. The field-test interview participants found the questionnaires relevant, comprehensible and easy to complete. Psychometric analyses showed that the German adaptations were successful. High test-retest coefficients for the scales after controlling for change in respondent9s QoL (FC: 0.92 to 0.96; EC: 0.85 to 0.99) indicated a high degree of reliability. The CAMPHOR scales had good internal consistency (Cronbach9s alpha coefficients .90 to .92 and .88 to .92, respectively). Also the three CAMPHOR scales (symptoms, activity limitations and quality of life) had excellent test-retest reliability (r=.90-0.91, P .90). Predicted correlations with the NYHA class, the 6-minute walking distance and the Nottingham Health Profile provided evidence of an excellent construct and group validity of the CAMPHOR scales. Conclusions: We have shown the CAMPHOR to be valid and reliable in the German population and recommend its use in clinical practice.
