A nurse-initiated clinical audit to evaluate a change in calcineurin inhibitor regime post-lung transplant

Lung transplantation (LTx) is now an established treatment for end-stage lung disease; however, rejection in both the acute and chronic forms remains the greatest barriers to its long-term success. Since the introduction of cyclosporine over 25 years ago, the risk of mortality from rejection post-LTx has significantly reduced. For 18 years from 1990 to 2008, the standard post-LTx immunosuppression regime at the Alfred Hospital (the Alfred) remained the same. Currently a wide variety of LTx immunosuppression strategies are being applied around the globe and in 2008, following Pharmaceutical Benefits Scheme (PBS) approval, the Alfred LTx consultants made the decision to switch all de-novo LTx recipients from cyclosporine to tacrolimus. This paper will discuss the result of a clinical audit to evaluate the feasibility, efficacy and safety of this change in immunosuppression strategy.