Immunosuppressive drug therapy for preventing rejection following lung transplantation in cystic fibrosis

BACKGROUND: For patients with cystic fibrosis and advanced pulmonary damage, lung transplantation is an available and viable option. However, graft rejection is an important potential consequence after lung transplantation. Immunosuppressive therapy is needed to prevent episodes of graft rejection and thus subsequently reduce morbidity and mortality in this population. There are a number of classes of immunosuppressive drugs which act on different components of the immune system. There is considerable variability in the use of immunosuppressive agents after lung transplantation in cystic fibrosis. While much of the research in immunosuppressive drug therapy has focused on the general population of lung transplant recipients, little is known about the comparative effectiveness and safety of these agents in patients with cystic fibrosis. OBJECTIVES: To assess the effects of individual drugs or combinations of drugs compared to placebo or other individual drugs or combinations of drugs in preventing rejection following lung transplantation in patients with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register and scanned references of the potentially eligible study. We also searched the www.clinicaltrials.gov trials registry to obtain information on unpublished and ongoing studies. Date of latest search: 22 August 2013. SELECTION CRITERIA: Randomised and quasi-randomised studies. DATA COLLECTION AND ANALYSIS: We independently assessed the studies identified from our searches for inclusion in the review. Should eligible studies be identified and included in future updates of the review, we will independently extract data and assess the risk of bias. MAIN RESULTS: While two studies met our inclusion criteria, we did not include them in the review because the investigators of the studies did not report any information specific to patients with cystic fibrosis. Our attempts to obtain this information have not yet been successful. We will include any provided data in future updates of the review. AUTHORS' CONCLUSIONS: The lack of currently available evidence makes it impossible to make conclusions about the comparative efficacy and safety of the various immunosuppressive drugs among patients with cystic fibrosis after lung transplantation. A recent Cochrane review comparing tacrolimus with cyclosporine in all patients with lung transplantation (not restricted to patients with cystic fibrosis) reported no significant difference in mortality and risk of acute rejection. However, tacrolimus use was associated with lower risk of broncholitis obliterans syndrome and arterial hypertension and higher risk of diabetes mellitus. It should be noted that this review contained only a small number of included studies (n = 3) with a high risk of bias. Additional randomised studies are required to provide evidence for the benefit and safety of the use of immunosuppressive therapy among patients with cystic fibrosis after lung transplantation.