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Immunosuppression for Lung Transplantation: Current and Future

  • Thoracic Transplantation (J Kobashigawa, Section Editor)
  • Published:
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Abstract

Purpose of the Review

The number of lung transplantations performed worldwide continues to increase. There is a growing need in these patients for more effective immunosuppressive medications with less toxicity.

Recent Findings

This review article summarizes the recent studies and developments in lung transplant immunosuppression. Novel immunosuppressive medications and strategies used in other solid organ transplantations are being trialed in lung transplantation. This includes the use of co-stimulation blockers like belatacept and mTOR inhibitors like everolimus. Calcineurin-sparing regimens have been described in an attempt to minimize nephrotoxicity. Assays to measure the bioactivity of immunosuppressive medications to determine the global immune competence, such as Immuknow assay and Gamma interferon response are gaining traction.

Summary

Immunosuppression in lung transplant is evolving with the development of newer drugs and promising strategies to optimize immunosuppression. Further studies with multicenter randomized trials are required to increase the strength of the evidence.

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Abbreviations

mTOR:

Mammalian target of rapamycin

ACR:

Acute cellular rejection

Il-2R:

Interleukin-2 receptor

CNI:

Calcineurin Inhibitors

TAC:

Tacrolimus

BOS:

Bronchiolitis obliterans syndrome

AZA:

Azathioprine

6MP:

6-Mercaptopurine

MMF:

Mycophenolate mofetil

MPA:

Mycophenolic acid

SRL:

Sirolimus

FKBP12:

FK506 binding protein 12

BELA:

Belatacept

CTLA4:

Cytotoxic T-lymphocyte–associated antigen 4 (CTLA4)

TTP:

Thrombotic thrombocytopenic purpura

PRES:

Posterior reversible encephalopathy syndrome

ER:

Extended-release

TTR:

Time-in-therapeutic-range

CLAD:

Chronic lung allograft disease

AKI:

Acute kidney injury

GFR:

Glomerular filtration rate

CMV:

Cytomegalovirus

AMR:

Antibody mediated rejection

BTZ:

Bortezomib

DSA:

Donor specific antibodies

CFZ:

Carfilzomib

IVIG:

Intravenous immunoglobulin

ECU:

Eculizumab

IFN-Ɣ:

Plasma interferon-gamma

ISHLT:

the International Society for Heart and Lung Transplantation

References

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Funding

CCK is supported by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN and the NHLBI grant K23 HL128859 from the National Institutes of Health. The manuscript’s contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Lung Transplantation Program, University of Florida, Gainesville, FL, USA

    Satish Chandrashekaran

  2. Pharmacy Services, Mayo Clinic, Rochester, MN, USA

    Stacy A. Crow & Chris J. Arendt

  3. William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA

    Stacy A. Crow, Chris J. Arendt & Cassie C. Kennedy

  4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA

    Sadia Z. Shah

  5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18S, 200 1st St. SW, Rochester, MN, 55905, USA

    Cassie C. Kennedy

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  1. Satish Chandrashekaran
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Correspondence to Cassie C. Kennedy.

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Chandrashekaran, S., Crow, S.A., Shah, S.Z. et al. Immunosuppression for Lung Transplantation: Current and Future. Curr Transpl Rep 5, 212–219 (2018). https://doi.org/10.1007/s40472-018-0199-4

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