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Immunosuppression for lung transplant recipients

  • Lung Transplant (M Zamora, Section Editor)
  • Published:
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Abstract

The choices and extent of immunosuppression critically affect subsequent infection and rejection profiles after lung transplantation (LTx). Evidence does not support a particular induction strategy. Typically, a three drug regimen of a calcineurin inhibitor, cell cycle inhibitor, and corticosteroids provide LTx maintenance immunosuppression. Other agents (including mTOR inhibitors), and other routes of administration (sublingual or inhaled) tend to be held back for specific clinical problems. Treatment of acute cellular rejection with high dose corticosteroids is usually successful. By contrast, treatment of antibody–mediated rejection is problematic. It requires a combination of high dose corticosteroids, plasmapheresis, rituximab, and intravenous immunoglobulin. Chronic lung rejection is a particular challenge to treat. It is generally stated that any change in immunosuppression can lead to an apparent stabilization. Azithromycin and statins have some efficacy when used early. The current review aims to highlight the rationale for current immunosuppressive choices and draw attention to recent trends and developments.

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Acknowledgement

The authors wish to acknowledge the support of the Margaret Pratt Foundation in the writing of this review.

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No authors have a conflict of interest with regard to this article.

Human and Animal Rights and Informed Consent

This article is a review article and does not contain any studies with human or animal subjects performed by any of the authors that have not been published elsewhere, with all subjects previously giving informed consent under Institutional Ethics Committee approval.

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  1. Lung Transplant Service, Alfred Hospital and Monash University, C/O 5Th Floor, Alfred Hospital, Commercial Rd, Melbourne, 3004, Australia

    Gregory I. Snell, Miranda A. Paraskeva, Bronwyn J. Levvey & Glen P. Westall

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  1. Gregory I. Snell
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  2. Miranda A. Paraskeva
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  3. Bronwyn J. Levvey
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  4. Glen P. Westall
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Correspondence to Gregory I. Snell.

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Snell, G.I., Paraskeva, M.A., Levvey, B.J. et al. Immunosuppression for lung transplant recipients. Curr Respir Care Rep 3, 88–95 (2014). https://doi.org/10.1007/s13665-014-0081-5

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  • DOI: https://doi.org/10.1007/s13665-014-0081-5

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