Azathioprine discontinuation and medium and long term outcomes after lung transplantation

Introduction: Azathioprine is part of conventional maintenance immunosuppressive regimens in lung transplant recipients, but myelosuppression and hepatotoxicity can commonly lead to drug discontinuation. Aim of this study is to evaluate outcomes in patients who discontinued azathioprine in comparison to those who received long term triple therapy. Methods: A retrospective study was conducted including all lung tranplant recipients from january 2009 to october 2013. All patients received post-operative triple immunosuppression therapy with tacrolimus, prednisone and azathioprine. Two groups of patients were identified: those who early discontinued azathioprine because of side effects and the rest of population. Results: 71 patients were considered. 42 (59%) patients were intolerant to azathioprine. Medium term outcomes are shown in Table 1. Incidence of CLAD was significantly higher in patients who early discontinued azathioprine (11 pts, 32% vs. 0, 0%, p=0.012); no difference was found in terms of incidence of neoplasms between the two groups. Conclusions: Although best FEV1 within the 1st year was significantly reduced, azathioprine intolerance did not represent a risk for medium term outcomes, whilst patients who tolerated triple immunosuppressive regimen seemed to be protected from CLAD.