Students Research in Progress
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction: Calcineurin inhibitors (CNIs) are the standard backbone of immunosuppressive therapy in lung transplant patients, but they have potential treatment-limiting adverse effects There is limited information about patients who do not tolerate CNIs.
Research Question or Hypothesis: The purpose of this study is to analyze patient survival with CNI-free immunosuppressive.
Study Design: This was an IRB-approved single-center, retrospective study included adult lung transplant recipients who received their first lung transplant between 10/12/07 to 11/09/22.
Methods: A patient who permanently discontinued the use of a CNI, or “CNI free,” was defined as a period of discontinuation of at least 30 days and did not resume CNI. Patients were matched to a standard immunosuppression control group matched for age, sex, time from transplant, and transplant indication. The primary endpoint was patient survival between CNI free and CNI continued. We also sought to describe alternative immunosuppressive strategies for CNI free patients. Descriptive statistics were used to characterize patients at baseline. Survival was estimated using Kaplan-Meier methods.
Results: 32 in CNI free patients were identified and matched with 32 controls. The average time from transplant to CNI discontinuation in the CNI free group was 21 months. 13 (41%) CNI free patients and 7 (22%) controls died during the study period. Among those that died, mean post-transplant survival was 47.6 months (mean 21.0 months from CNI discontinuation) and 52.4 months for controls, but survival was not statistically different on Kaplan-Meier analysis (p=0.29). Chronic lung allograft dysfunction developed in 6 CNI free patients and 8 controls. Characterization and analysis of CNI free regimens is ongoing.
Conclusion: Mean survival time in patients who stop CNI post-lung transplant was shorter versus controls, but this did not reach statistical significance in this study. Addition studies are needed to evaluate alternative immunosuppressive regimens in patients who do not tolerate CNI.
Presenting Author
Roma Usgoankar PharmD Candidate Class of 2025University of Pittsburgh
Authors
Jessica Abbott PharmD Candidate 2025
University of Pittsburgh
Ben Herrmann PharmD
University of Pittsburgh
Carlo Iasella PharmD, MPH
University of Pittsburgh