Calcineurin inhibitors and Clostridium difficile infection in adult lung transplant recipients: The effect of cyclosporine versus tacrolimus

Janet T Lee, Bryan A. Whitson, Rosemary F Kelly, Jonathan D'Cunha, Jordan M Dunitz, Marshall I Hertz, Sara J Shumway

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4 Citations (Scopus)

Abstract

Background: Tacrolimus (FK506) has a superior immunosuppressive effect compared with cyclosporine (CSA) without a significant increase in generalized infectious complications. Differences in specific infections such as Clostridium difficile (CDI) have not been reported. We investigated the relationship between calcineurin inhibitors and CDI, hypothesizing that choice of calcineurin inhibitor (CSA or FK506) after lung transplantation would have no effect on the incidence of CDI. Methods: We performed a retrospective chart review of lung transplant recipients between June 1, 2000, and December 31, 2005, at a single institution. Positive CDI assays through December 11, 2011, were also recorded. We used Student's t- and chi-squared tests (α = 0.05) to compare CSA and FK506 groups. We calculated adjusted hazard ratios for CDI using Cox proportional hazard models. Results: We identified 217 lung transplant recipients: 106 patients in the CSA group and 111 patients in the FK506 group. A total of 31 patients (27.9%) in the FK506 group developed CDI postoperatively compared with 20 patients (18.9%) in the CSA group (P = 0.16). The adjusted hazard ratio for CDI in the FK506 group was not significantly higher (1.53; 95% confidence interval, 0.78-2.98).Therewasnosignificant differenceintheintensive care unit or total length of stay, in-hospital incidence rate, timeto firstCDI episode, or recurrence rate between groups. Conclusions: The CDI rates were not significantly higher in the FK506 group than the CSA group in our study. These data are consistent with previous studies on FK506 that show no increase in infectious complications over CSA, and demonstrate its continued safety in lung transplantation.

Original languageEnglish (US)
Pages (from-to)599-604
Number of pages6
JournalJournal of Surgical Research
Volume184
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Clostridium Infections
Clostridium difficile
Tacrolimus
Cyclosporine
Lung
Lung Transplantation
Calcineurin Inhibitors
Transplant Recipients
Incidence
Immunosuppressive Agents
Proportional Hazards Models
Length of Stay
Confidence Intervals
Students
Safety
Recurrence

Keywords

  • Calcineurin inhibitors
  • Clostridium difficile
  • Cyclosporine
  • Immunosuppression
  • Lung transplantation
  • Tacrolimus
  • Transplant infections

Cite this

@article{1ee9b8b1d3624a2a8d2dd26986b9bf86,
title = "Calcineurin inhibitors and Clostridium difficile infection in adult lung transplant recipients: The effect of cyclosporine versus tacrolimus",
abstract = "Background: Tacrolimus (FK506) has a superior immunosuppressive effect compared with cyclosporine (CSA) without a significant increase in generalized infectious complications. Differences in specific infections such as Clostridium difficile (CDI) have not been reported. We investigated the relationship between calcineurin inhibitors and CDI, hypothesizing that choice of calcineurin inhibitor (CSA or FK506) after lung transplantation would have no effect on the incidence of CDI. Methods: We performed a retrospective chart review of lung transplant recipients between June 1, 2000, and December 31, 2005, at a single institution. Positive CDI assays through December 11, 2011, were also recorded. We used Student's t- and chi-squared tests (α = 0.05) to compare CSA and FK506 groups. We calculated adjusted hazard ratios for CDI using Cox proportional hazard models. Results: We identified 217 lung transplant recipients: 106 patients in the CSA group and 111 patients in the FK506 group. A total of 31 patients (27.9{\%}) in the FK506 group developed CDI postoperatively compared with 20 patients (18.9{\%}) in the CSA group (P = 0.16). The adjusted hazard ratio for CDI in the FK506 group was not significantly higher (1.53; 95{\%} confidence interval, 0.78-2.98).Therewasnosignificant differenceintheintensive care unit or total length of stay, in-hospital incidence rate, timeto firstCDI episode, or recurrence rate between groups. Conclusions: The CDI rates were not significantly higher in the FK506 group than the CSA group in our study. These data are consistent with previous studies on FK506 that show no increase in infectious complications over CSA, and demonstrate its continued safety in lung transplantation.",
keywords = "Calcineurin inhibitors, Clostridium difficile, Cyclosporine, Immunosuppression, Lung transplantation, Tacrolimus, Transplant infections",
author = "Lee, {Janet T} and Whitson, {Bryan A.} and Kelly, {Rosemary F} and Jonathan D'Cunha and Dunitz, {Jordan M} and Hertz, {Marshall I} and Shumway, {Sara J}",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.jss.2013.03.041",
language = "English (US)",
volume = "184",
pages = "599--604",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

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TY - JOUR

T1 - Calcineurin inhibitors and Clostridium difficile infection in adult lung transplant recipients

T2 - The effect of cyclosporine versus tacrolimus

AU - Lee, Janet T

AU - Whitson, Bryan A.

AU - Kelly, Rosemary F

AU - D'Cunha, Jonathan

AU - Dunitz, Jordan M

AU - Hertz, Marshall I

AU - Shumway, Sara J

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Tacrolimus (FK506) has a superior immunosuppressive effect compared with cyclosporine (CSA) without a significant increase in generalized infectious complications. Differences in specific infections such as Clostridium difficile (CDI) have not been reported. We investigated the relationship between calcineurin inhibitors and CDI, hypothesizing that choice of calcineurin inhibitor (CSA or FK506) after lung transplantation would have no effect on the incidence of CDI. Methods: We performed a retrospective chart review of lung transplant recipients between June 1, 2000, and December 31, 2005, at a single institution. Positive CDI assays through December 11, 2011, were also recorded. We used Student's t- and chi-squared tests (α = 0.05) to compare CSA and FK506 groups. We calculated adjusted hazard ratios for CDI using Cox proportional hazard models. Results: We identified 217 lung transplant recipients: 106 patients in the CSA group and 111 patients in the FK506 group. A total of 31 patients (27.9%) in the FK506 group developed CDI postoperatively compared with 20 patients (18.9%) in the CSA group (P = 0.16). The adjusted hazard ratio for CDI in the FK506 group was not significantly higher (1.53; 95% confidence interval, 0.78-2.98).Therewasnosignificant differenceintheintensive care unit or total length of stay, in-hospital incidence rate, timeto firstCDI episode, or recurrence rate between groups. Conclusions: The CDI rates were not significantly higher in the FK506 group than the CSA group in our study. These data are consistent with previous studies on FK506 that show no increase in infectious complications over CSA, and demonstrate its continued safety in lung transplantation.

AB - Background: Tacrolimus (FK506) has a superior immunosuppressive effect compared with cyclosporine (CSA) without a significant increase in generalized infectious complications. Differences in specific infections such as Clostridium difficile (CDI) have not been reported. We investigated the relationship between calcineurin inhibitors and CDI, hypothesizing that choice of calcineurin inhibitor (CSA or FK506) after lung transplantation would have no effect on the incidence of CDI. Methods: We performed a retrospective chart review of lung transplant recipients between June 1, 2000, and December 31, 2005, at a single institution. Positive CDI assays through December 11, 2011, were also recorded. We used Student's t- and chi-squared tests (α = 0.05) to compare CSA and FK506 groups. We calculated adjusted hazard ratios for CDI using Cox proportional hazard models. Results: We identified 217 lung transplant recipients: 106 patients in the CSA group and 111 patients in the FK506 group. A total of 31 patients (27.9%) in the FK506 group developed CDI postoperatively compared with 20 patients (18.9%) in the CSA group (P = 0.16). The adjusted hazard ratio for CDI in the FK506 group was not significantly higher (1.53; 95% confidence interval, 0.78-2.98).Therewasnosignificant differenceintheintensive care unit or total length of stay, in-hospital incidence rate, timeto firstCDI episode, or recurrence rate between groups. Conclusions: The CDI rates were not significantly higher in the FK506 group than the CSA group in our study. These data are consistent with previous studies on FK506 that show no increase in infectious complications over CSA, and demonstrate its continued safety in lung transplantation.

KW - Calcineurin inhibitors

KW - Clostridium difficile

KW - Cyclosporine

KW - Immunosuppression

KW - Lung transplantation

KW - Tacrolimus

KW - Transplant infections

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U2 - 10.1016/j.jss.2013.03.041

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