Inhaled drug shown to decrease rejection

The anti-rejection drug is delivered directly to the organs as an inhaled mist.
WASHINGTON (AP) -- Scientists have created a way for transplant recipients to inhale an anti-rejection drug deep into their new lungs -- and a study unveiled Saturday suggests the therapy may increase patients' chances of survival fourfold.
Organ-specific anti-rejection therapy is a novel approach, and this inhaled version of cyclosporine remains experimental. Its creators at the University of Pittsburgh are working with a drug company to seek government approval for its sale.
Doctors say the new approach holds promise in battling a huge problem for lung transplantation -- a type of rejection that makes it a particularly perilous organ transplant.
"It makes good sense to apply the immuno-suppressive agent right to the location where the problem exists," said Dr. Ed Garrity, director of lung transplants at Loyola University Medical Center.
Reviewing Pitt's research, "it looks like it works," Garrity said.
Very risky transplant
Lung transplants are among the riskiest of organ transplants, and patients' odds haven't improved significantly in over a decade.
About 45 percent of lung recipients survive five years, compared with 75 percent of recipients of hearts, livers and kidneys, said Dr. Aldo Iacono, lung-transplant chief at the University of Pittsburgh Medical Center.
The main reason: A newly implanted lung is particularly vulnerable to chronic rejection, a gradual scarring called "bronchiolitis obliterans" that eventually destroys it.
"This is the Achilles heel of the lung transplantation process," Iacono said.
Organ recipients take a cocktail of immune-suppressing pills, often including cyclosporine, to ward off both immediate and chronic forms of rejection.
But Iacono theorized that getting anti-rejection therapy directly into the lungs might provide greater protection for those patients, by fending off immune cells' attack of the delicate tissue right at the source.
Inhaled as a mist
So Pitt researchers dissolved powdered cyclosporine, donated by Novartis Pharmaceuticals, into another chemical so it can be inhaled as a mist using a nebulizer, much like certain asthma medications are.
Then, in a study funded by the National Institutes of Health, they divided 56 new lung recipients into two groups. Everyone got standard anti-rejection treatment. But half also were given the inhalable cyclosporine and half a dummy nebulizer, to use three days a week for two years after their transplant.
Patients were tracked for two to five years. Eleven percent who inhaled cyclosporine died in that time period -- compared with 47 percent who got the placebo, Iacono told a meeting of the International Society for Heart and Lung Transplantation on Saturday.
A mixture of lung biopsies and lung-function tests showed the cyclosporine prevented chronic rejection, he added. Signs of rejection ranged from 19 percent to 39 percent of cyclosporine patients, depending on the test used, compared with 60 percent to 70 percent of placebo patients.
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