Current Transplantation Reports

, Volume 5, Issue 3, pp 212–219 | Cite as

Immunosuppression for Lung Transplantation: Current and Future

  • Satish Chandrashekaran
  • Stacy A. Crow
  • Sadia Z. Shah
  • Chris J. Arendt
  • Cassie C. KennedyEmail author
Thoracic Transplantation (J Kobashigawa, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Thoracic Transplantation


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.


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.


Lung transplantation Immunosuppression Calcineurin-sparing regimens Global immune competence 



Mammalian target of rapamycin


Acute cellular rejection


Interleukin-2 receptor


Calcineurin Inhibitors




Bronchiolitis obliterans syndrome






Mycophenolate mofetil


Mycophenolic acid




FK506 binding protein 12




Cytotoxic T-lymphocyte–associated antigen 4 (CTLA4)


Thrombotic thrombocytopenic purpura


Posterior reversible encephalopathy syndrome






Chronic lung allograft disease


Acute kidney injury


Glomerular filtration rate




Antibody mediated rejection




Donor specific antibodies




Intravenous immunoglobulin




Plasma interferon-gamma


the International Society for Heart and Lung Transplantation


Financial Support

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.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major Importance

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Satish Chandrashekaran
    • 1
  • Stacy A. Crow
    • 2
    • 3
  • Sadia Z. Shah
    • 4
  • Chris J. Arendt
    • 2
    • 3
  • Cassie C. Kennedy
    • 3
    • 5
    Email author
  1. 1.Division of Pulmonary, Critical Care and Sleep Medicine, Lung Transplantation ProgramUniversity of FloridaGainesvilleUSA
  2. 2.Pharmacy ServicesMayo ClinicRochesterUSA
  3. 3.William J. von Liebig Center for Transplantation and Clinical RegenerationMayo ClinicRochesterUSA
  4. 4.Division of Pulmonary and Critical Care MedicineMayo ClinicScottsdaleUSA
  5. 5.Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA

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