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Induction and maintenance immunosuppression in lung transplantation

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Abstract

Immunosuppression for lung transplant recipients is a critical part of post-transplant care, to prevent acute and chronic rejection. Treatment protocols consist of induction and maintenance immunotherapy. Induction agents provide an immediate state of immunosuppression following transplantation and over time, and their use has become more commonplace. Several agents are available for clinical use, including anti-thymocyte globulin, alemtuzumab, and basiliximab, the latter being most commonly employed. Each induction agent has unique side effects and caveats to their use, of which we must be aware. Maintenance immunosuppression is initiated following transplant but requires multiple doses prior to reaching therapeutic levels. A calcineurin inhibitor, an anti-metabolite, and a corticosteroid are traditionally used, most commonly tacrolimus, mycophenolate mofetil, and prednisone. Dosing regimens and goal trough levels vary and are tailored to a patient’s clinical status and duration post-transplant. Future clinical studies may be able to assist in determining the optimal induction and maintenance immunosuppression regimens. In the interim, we use cohort and registry data to guide our therapies.

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Acknowledgements

The authors thank Kristina Bailey for her editing assistance.

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Authors and Affiliations

  1. Department of Pulmonary, Critical Care of Sleep, University of Nebraska Medical Center, 985910 Nebraska Medical Center, Omaha, NE, 68198-5910, USA

    Bronwyn Small & Heather Strah

  2. Department of Pharmacy, Temple University Hospital, Philadelphia, PA, USA

    Jenny Au & Ishani Shah

  3. Department of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA

    Heidi Brink

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  1. Bronwyn Small
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B. Small began the idea for the article. B. Small; J. Au; H. Brink; and I. Shah completed the literature search and drafted the work. H. Strah created the figure and critically revised the work.

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Correspondence to Bronwyn Small.

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Small, B., Au, J., Brink, H. et al. Induction and maintenance immunosuppression in lung transplantation. Indian J Thorac Cardiovasc Surg 38 (Suppl 2), 300–317 (2022). https://doi.org/10.1007/s12055-021-01225-x

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