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Immunosuppression and Allograft Rejection Following Lung Transplantation: Evidence to Date

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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.

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Conflict of interest

Miranda A. Paraskeva has no conflicts of interest. Glen P. Westall has received speakers fees from Roche. Gregory I. Snell has received speakers fees for speaking at a Roche symposium in 2012.

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  1. Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, VIC, Australia

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

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  1. Gregory I. Snell
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Correspondence to Gregory I. Snell.

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Snell, G.I., Westall, G.P. & Paraskeva, M.A. Immunosuppression and Allograft Rejection Following Lung Transplantation: Evidence to Date. Drugs 73, 1793–1813 (2013). https://doi.org/10.1007/s40265-013-0136-x

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