Lung transplantation without the use of antilymphocyte antibody preparations

Survival, infection, and rejection rates and functional data are reported in 35 lung recipients treated with triple-drug immunosuppression without antilymphocytic antibody therapy. Early mortality (less than 60 days) was 6%. Thirty recipients (86%) are alive, with a mean follow-up period of 16 months (range, 1 to 36 months). Actuarial survival was 91% at 1 year and 83% at 2 years. Thirty-seven infections occurred in 24 patients. Actuarial freedom from infection was 61% at 3 months and 27% at 1 year. Only one patient died of infection (aspergillosis). Thirty-six episodes of acute rejection were treated in 23 patients. Time to first rejection was 14 ± 7.8 days. Actuarial freedom from acute rejection was 36% at 2 months. Significant functional improvement was evident in all operative survivors. Pulmonary function and exercise performance data in patients without bronchiolitis obliterans remain stable 1 year after transplantation. We conclude that the use of triple-drug immunosuppression without antilymphocytic antibody preparations in lung transplantation provides effective immunosuppression with a low risk of serious infectious complications.