August 1, 2005 Half of all lung transplant patients don't live past the fifth year after the procedure, due in part to chronic rejection of the new organs. A new, inhaled form of a commonly used anti-rejection drug deliverers the drug faster and more precisely. Clinical trials show patients have an 84 percent better chance at surviving four years after the surgery.
BALTIMORE--Transplant surgery is always risky. Not just the surgery, but also living life after a transplant. A new treatment is helping some patients live longer, healthier lives.
Before Esther Suss received her lung transplant, late-stage emphysema -- a lung disease -- had her catching her breath. "I couldn't walk five blocks to go to lunch without having to use the oxygen," she says. "Even then I would be exhausted." Surviving several years after surgery, Suss is beating the odds, doing absolutely great.
Pulmonologist Aldo Iacono, of the University of Maryland Medical Center in Baltimore, says her success could be a result of a new inhaled form of a commonly used anti-rejection drug called cyclosporine. He says it improves survival five-fold.
After transplant surgery, the body can refuse the new lung in a condition called chronic rejection. But inhaling the drug has now been shown to halt this fatal condition in some patients. When it's taken orally, it has to be absorbed by the blood and circulated through the body. But after inhaling the drug, it's delivered directly into tiny airways critical for breathing. The inhaled medicine is a faster, more precise way of taking the anti-rejection medication.
Dr. Iacono says, "This should be a drug that provides substantial benefit to patients."
That's good news for Suss. "I got my life back, and it was worth it." She plans on breathing easier with her family for many more years.
Clinical trial results showed patients on the inhaled drug have an 84-percent better chance at surviving four years after surgery. For more information about the lung transplant program at the University of Maryland Medical Center, call 800-492-5538 or visit www.umm.edu.
BACKGROUND: A widely used pill that keeps the body from rejecting an organ transplant has been converted into an aerosol solution that can be inhaled. A recent study indicates that over four and a half years, 84 percent of patients on the inhaled medicine survived, compared to only 56 percent of those on a placebo.
THE PROBLEM: Compared to other organ transplants, long-term survival rates following a lung transplant have not increased much over the last decade or so. Seventy-five percent of people with a lung transplant survived for the first year, but only 45 percent lived for five years after the transplant. In comparison, more than 70 percent of heart, liver and kidney transplant patients now survive more than five years. Scientists believe this is because a transplanted lung must breathe in everyday impurities in the air, triggering a rejection response in the lung.
BENEFITS: The aerosol form of cyclosporine delivers the drug more effectively to the tiny sensitive airways of the lung, where the threat of rejection is most serious. It also solves a toxicity problem: patients are unable to take larger doses of the pill format because it can lead to kidney damage. But the inhaled version can be taken in much higher dosages without increasing the level of toxicity.
WHERE TO GET IT: Chiron Corporation has licensed the inhaled version of cyclosporine, which came on the market in July.
ABOUT LUNG TRANSPLANT REJECTION: Any organ transplant carries with it the risk that the recipient's immune system would reject the organ. The body identifies the donated lungs as a foreign invader and attacks the transplanted organ. There are different kinds of organ rejection. Acute rejection involves blood vessels in the lungs; it usually occurs in the first three months after a transplant, and can be treated with anti-rejection drugs like cyclosporine. Chronic rejection occurs in the airways and becomes more resistant to treatment over time.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.