Quantification of Torque Teno Virus and Epstein-Barr Virus Is of Limited Value for Predicting the Net State of Immunosuppression After Lung Transplantation

Nordén, Rickard; Magnusson, Jesper; Lundin, Anna; Tang, Ka-Wei; Nilsson, Staffan; Lindh, Magnus; Andersson, Lars-Magnus; Riise, Gerdt C; Westin, Johan

Induction therapy consisted of rabbit antithymocyte globulin, which was given for 1-3 consecutive days together with methylprednisolone intravenously. Post-transplantation immunosuppression included prednisone 0.3 mg/kg/d and mycophenolate mofetil (MMF) 2 g/d. The patients then received either oral Cyclosporine (CSA; 1-2 mg/kg), adjusted to maintain a serum level of 300-350 ng/mL, or Tacrolimus (TAC; 0.075 mg/kg) given orally divided in 2 doses daily, adjusted to maintain a serum level of 14-16 ng/mL. The choice between CSA and TAC was made based on clinical presentation. Patients previously treated with TAC and patients with cystic fibrosis were given TAC. There was also a preference for TAC if the recipient was younger. The dosage of immunosuppression was gradually lowered during FU. Further changes in immunosuppressive therapy were based on clinical presentation. Four patients, who either underwent retransplantation or had previous immunosuppressive treatment due to autoimmune conditions, were given nonstandard immunosuppression therapy based on previous exposure to immunosuppressive drugs.