Piper, I have many friends who had their tx at USC!! They love the center, the team and are doing well. Many of them had living lobar tx, as USC and Dr. Starnes is the creator of the living lobar.As of now, post lung tx recips are on prednisone for the rest of their lives. But there are a few people who are not. I think that those folks never had rejection, and they are from centers that are trying new approaches to post tx maintenance. Univ of Pittsburgh in Pennsylvania is a very cutting edge center and they are trying a very aggressive program. In fact, I am going to try to find 2 recent articles that came out of medical journals that are about what UPMC is doing about the meds. Sounds exciting for those of us who are waiting for lung tx, and those post tx. The jist of the article is "less is better" and that with the study they are doing, the survival was better with less. I will put the articles at the bottom of this message. Centers vary on the prednisone maintenance regime. Some go down to 5 mg every other day, some stay at every day. Ask your center. There are side effects of prednisone, but they are also treatable. Bone density - diabetes etc. I have both and being treated, with good results. The Moon Face... that is a personal thing. I have a slight moon face, on some days. My sister has no moon face. Let the team know about your past prednisone history. Also I will mention that drugs I took pre tx, react differently with me post tx. Could be the combination of drugs, the ability to breathe better, etc, not sure of the reason. It is fine to worry about your looks. You do learn to live with it, and for the most part I just remind myself on my puffy days, " small price to pay for living". Which when you really think about it.... it is truly a small price to pay. I know pre tx I was so concerned about the scar. But I can say at about 2 years post tx, you can barely see my scar, and the chest tube scars are a bit more obvious. In fact, I think I would have a hard time finding some of the scar. The surgeons do realize especially for women this is a great concern, so they do a very good job in making sure it is neat and "pretty". The scar is actually where the bottom of your bra is, so wearing a bikini you do not see the scar. But as I have learned, both men and women are very proud of their "war scar" and do not mind if people see it.Glad I can be of help. Here are the articles below.JoanneMay 2004 - University of Pittsburgh approach has lung recipients taking far fewer drugs. -Findings being presented at the American Transplant Congress. A lung transplant patient takes six pills a day, a regimen that is intended to safeguard the donor organ from immune system attack. But rejection plagues these patients more often and more vigorously than any other kind of organ recipient, so is it necessary that patients take that many pills? Not according to the experience of surgeons at the University of Pittsburgh Medical Center (UPMC), where some lung transplant recipients are getting away with taking just one anti-rejection pill daily, and others just the one pill four or five times a week, with no ill effects.Results of the novel clinical protocol were presented today by Kenneth McCurry, M.D., assistant professor of surgery at the University of Pittsburgh School of Medicine, at the American Transplant Congress (ATC), the joint scientific meeting of the American Society of Transplant Surgeons and the American Society of Transplantation.With more than a year of follow-up in many patients, Dr. McCurry found that even those patients who have been able to reduce their medications to one pill a day benefit from the approach, which differs from the conventional twice-a-day triple-drug therapy, said Dr. McCurry. "Bombarding the immune system with several very potent drugs has done little to improve the outcomes for lung transplant recipients, who continue to have poor survival about 75 percent at one year compared to other organ recipients. Moreover, the drugs have not done well to prevent chronic rejection, which affects about half of lung transplant patients by five years and usually results in organ failure and death. These bleak outcomes have motivated us to introduce an approach that we hope will enhance long-term survival, reduce the rates of complications associated with these drugs and improve quality of life," said Dr. McCurry, who also is director of lung and heart-lung transplantation at UPMC.The approach is the only one of its kind involving lung transplant patients, in whom studies that seek to reduce anti-rejection drugs are rarely performed out of fear that the lungs, already the most vulnerable organ to rejection, would succumb to an irreversible immune system attack, placing patients at risk for death. Ironically, lung recipients have the greatest incidence of immunosuppression-related complications, such as infection and chronic kidney dysfunction, providing incentive to search for alternative immunosuppression approaches. UPMC's clinical protocol involves a one-time dose of a drug that depletes T cells key immune system cells that are known to target the donor organ that is given just before transplantation. Following transplantation, patients are treated with just one anti-rejection drug, tacrolimus, that is administered at reduced levels. Since many lung recipients are treated with prednisone for their underlying disease, the steroid is continued after transplant but at a negligible dose, 5 mg compared to 20 mg.The rationale is to treat patients with as little immunosuppressive medication as possible following the transplant while preventing injury to the graft by the recipient's immune system. Since June of 2002, more than 80 patients have been treated under the protocol. At ATC, Dr. McCurry reported results in many of these patients, including 31 who have been followed for more than a year after transplant, several for nearly two years. The first 38 patients were given a pre-transplant drug called Thymoglobulin. One-year survival for these patients is 87 percent. The remaining patients received Campath, which appears to deplete T cells more broadly and for a longer period of time. Acute rejection episodes have been less in the Campath patients reported on at ATC compared to those who received Thymoglobulin. Twenty-five of the 38 Thymoglobulin patients had rejection episodes greater or equal to Grade 2, compared to two of the first10 Campath treated patients.There were no opportunistic infections or related complications in the patients treated with Campath; a small percentage of the Thymoglobulin patients developed either cytomegalovirus (8 percent), the bacterial infection Nocardia (8 percent) or post-transplant lymphoproliferative disorder (3 percent), rates that were comparable to conventionally treated patients. One-year follow-up results are not yet available to compare survival between the Thymoglobulin-treated and Campath-treated groups. However, the overall patient survival for Thymoglobulin-treated patients is 84 percent while in the Campath-treated patients it is 98 percent. "We are encouraged by these preliminary results. What remains to be seen is if our approach will have an impact on chronic rejection," said Dr. McCurry. "At this point, I think we can say that the standard multi-drug approach to immunosuppression may be excessive and leads to increased complications. Moreover, our promising early results suggest that altering the approach and reducing immunosuppression is not as risky as some would have guessed. The next step we should consider is a multi-center, randomized trial. Only with that kind of data might the transplant community embrace the notion that radical change is warranted," noted Dr. McCurry. "Personally, I think our approach will presage significant improvements in outcomes for lung transplantation," he added. To schedule interviews with Dr. McCurry call Lisa Rossi at 412-916-3315. Additional Contact Information: Lisa Rossi (cell 412-916-3315) Maureen McGaffin PHONE: 412-647-3555 FAX: 412-624-3184 E-MAIL: McgaffinME@upmc.edu --------------------------------------------------------------------------------Lung Transplant Patients Successfully Tapered to Monotherapy Using Alemtuzumab Medscape Medical News 2004 Early results of an ongoing protocol show that both the number of immunosuppressive agents taken and the dose of each can be reduced in lung transplant patients, and with very littleacute rejection, researchers said here Sunday.The study was presented by Kenneth R. McCurry, MD, from the University of Pittsburgh Medical Center in Pennsylvania, at the 2004 annual meeting of the American TransplantCongress, the joint meeting of the American Society of Transplant Surgeons and the American Society of Transplantation.At Pittsburgh, most transplant patients are being given induction therapy with a T cell depleting agent, followed by either no steroids or low-dose steroids and immunosuppressive monotherapy, usually tacrolimus. Dr. McCurry began his study in lung transplant patients in June 2002, administering thymoglobulin as the induction agent. That protocol was followed until June 2003, when new transplant patients were instead given alemtuzumab for induction.Most lung transplant patients also continued to receive a low dose of prednisone 5 mg (compared with the conventional 20 mg). They also were given valganciclovir prophylaxis for six months beforetransplantation.Dr. McCurry focused his presentation on the 42 patients who had received alemtuzumab; results for the first 38 patients who received thymoglobulin were included in the abstract and not featured as prominently. Pittsburgh will be moving mostly to alemtuzumab as an induction agent in lung transplantation, said Dr. McCurry. The patients who received alemtuzumab ranged in age from 26 to 70 years; 17 received a single lung transplant, 22 received a double-lung transplant, and two received heart and lung transplants. With follow-up of one month to oneyear, 41 of the 42 transplant patients are still alive. Sixty-four percent have had no rejection; 14% had a grade 2 rejection, and only two of those 6 patients received treatment with steroids. Nine patients had a grade 3 or higher acute rejection episode.Thirty-nine patients are receiving tacrolimus monotherapy, and of those, three have tapered to four-times-weekly dosing. Three patients have added mycophenolate mofetil to their regimen. Pulmonary function is excellent, with patients having less than a 5% decline, said Dr. McCurry. There has been one case ofcytomegalovirus and one case of posttransplant lymphoproliferative disorder.Session moderator Mark Barr, MD, an associate professor of cardiothoracic surgery at the University of Southern California, Los Angeles, told attendees that while Dr. McCurry's results were impressive, he was concerned that Pittsburgh surgeons might not be able to predict which patients are more likely to reject, and that they might not be able to properly monitor for and thus, treat rejection. "This is a gutsy protocol," he told attendees, noting the higher rejection risk with lungtransplants.Dr. McCurry replied that there is no assay available to predict who might reject, and he later told Medscape that patients are closely monitored through biopsies for signs of rejection. And, he said, patients with chronic rejection would receive rescue medications such as IVIG.Stuart Knechtle, MD, a transplant surgeon at the University of Wisconsin Medical School in Madison who conducted many of the initial studies of alemtuzumab for induction, told Medscape that it is too early to say whether Dr. McCurry's results will hold. "I'd like to seecontinued follow-up," he said. But he added that he was not surprised by the positive results, saying "they are quite analogous to what we've seen" with other organs.Dr. Knechtle said the research also adds to the evidence that T-cell depletion plays a key role in helping to prevent rejection, and that it also helps head off longer-term problems with infection and malignancy by allowing surgeons to taper immunosuppressive therapy.Pittsburgh plans to continue treating all lung transplant patients with alemtuzumab followed by tacrolimus monotherapy, and willcontinue to report their results, Dr. McCurry said. --------------------------------------------------------------------------------