Drugs

, Volume 73, Issue 16, pp 1793–1813

Immunosuppression and Allograft Rejection Following Lung Transplantation: Evidence to Date

  • Gregory I. Snell
  • Glen P. Westall
  • Miranda A. Paraskeva
Review Article

DOI: 10.1007/s40265-013-0136-x

Cite this article as:
Snell, G.I., Westall, G.P. & Paraskeva, M.A. Drugs (2013) 73: 1793. doi:10.1007/s40265-013-0136-x

Abstract

The enduring success of lung transplantation is built on the use of immunosuppressive drugs to stop the immune system from rejecting the newly transplanted lung allograft. Most patients receive a triple-drug maintenance immunosuppressive regimen consisting of a calcineurin inhibitor, an antiproliferative and corticosteroids. Induction therapy with either an antilymphocyte monoclonal or an interleukin-2 receptor antagonist are prescribed by many centres aiming to achieve rapid inhibition of recently activated and potentially alloreactive T lymphocytes. Despite this generic approach acute rejection episodes remain common, mandating further fine-tuning and augmentation of the immunosuppressive regimen. While there has been a trend away from cyclosporine and azathioprine towards a preference for tacrolimus and mycophenolate mofetil, this has not translated into significant protection from the development of chronic lung allograft dysfunction, the main barrier to the long-term success of lung transplantation. This article reviews the problem of lung allograft rejection and the evidence for immunosuppressive regimens used both in the short- and long-term in patients undergoing lung transplantation.

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Gregory I. Snell
    • 1
  • Glen P. Westall
    • 1
  • Miranda A. Paraskeva
    • 1
  1. 1.Lung Transplant ServiceAlfred Hospital and Monash UniversityMelbourneAustralia