Tacrolimus

The lung transplantation was performed according to the protocol described by Mariscal et al.^{52 (link)}.
In brief, the pulmonary hilum was dissected through a left thoracotomy and the left pulmonary artery, left atrium, and left bronchus were clamped individually. A left pneumonectomy of the native left lung was performed thereafter. The donor lung was sewn in, and the anastomosis of the bronchus was sutured using polydioxanone sutures (PDS 4-0, Ethicon, Somerville, NJ, USA). The atrial cuff and the pulmonary artery were sutured with polypropylene (Prolene 5-0, Ethicon) using a continuous pattern. All animals were immunosuppressed using tacrolimus (0.15 mg/kg, orally,Sandoz AS, Copenhagen, Denmark), and methylprednisolone sodium succinate (1 mg/kg, intravenously, Solumedrol, Pfizer). After suturing the bronchus, a bronchoscopy was done to confirm an open bronchial anastomosis.

As induction agents, interleukin-2 receptor monoclonal antibody (basiliximab, Novartis Pharmaceuticals, Basel, Switzerland) and high-dose steroid (methylprednisolone starting with 500 mg intravenous for two days) were injected. To maintain of immunosuppression, calcineurin inhibitors (usually tacrolimus), anti-proliferative agents (mycophenolate mofetil or mycophenolate sodium), and steroids were administered. When the patient and donor had incompatibility with the ABO blood type, anti CD20 agent (rituximab) was administered at 2 weeks before transplantation followed by preoperative plasmapheresis. For patients who were at high risk of HCC recurrence, mammalian target of rapamycin inhibitor (sirolimus, Pfizer) was added at 1 month after transplantation with lowering serum drug level of tacrolimus.