Negative consequences of immunosuppressive therapy on bronchial healing following lung transplantation (LTx)

Introduction Immunosuppressive therapy presents with well-known anti-proliferative properties. We studied the impact of different immunosuppressive combinations on bronchial healing in LTx. Method We conducted a retrospective historical study on all LTx performed in a single center between January 2004 and May 2012. We recorded the demographic characteristics of the recipients and the donors. We focused on lung disease in the recipient, denutrition, surgical technique for transplantation, graft ischemia, primary graft dysfunction, mechanical ventilation support, lung infection, and the post-operative combination of immunosuppressive therapy. These characteristics were compared to bronchial complications defined as: (i) symptomatic dehiscence (extended chest tube drainage, need for surgery, recipient death) or (ii) symptomatic stenosis (bronchoscopic dilation or stenting). Results Among 169 LTx, we found 35 bronchial complications leading to death in 7 patients. Meanwhile 134 patients remained unharmed. Both groups received overall the same amount of steroids. Patients with the combination basiliximab/steroid/tacrolimus/mycophenolate had significantly more bronchial complications (p=0.03) in comparison to patients with the combination steroid/ ciclosporin/azathioprine . There was no significant difference for the other studied factors. Conclusion The combination basiliximab/steroid/tacrolimus/mycophenolate has a negative effect on bronchial healing. The anti-proliferative effects of immunosuppressive drugs should be studied when given in a combination and not as a single drug.