Immunosuppression in Lung Transplantation

  • Joshua A. Blatter
  • Peter H. Michelson
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


The goal of immunosuppression is to reduce the incidence of allograft rejection. Optimal immunosuppression involves minimizing side effects, such as infection and renal injury, while maximizing immune tolerance. Induction immunosuppression commonly entails systemic corticosteroids as well as an interleukin-2 receptor antagonist or a polyclonal antibody. Maintenance immunosuppression necessitates a three-drug regimen: systemic corticosteroids, as well as a calcineurin inhibitor and antimetabolite therapy (typically tacrolimus and mycophenolate mofetil). Renal side effects, both acute and chronic, are an ongoing challenge in calcineurin inhibition. Treatment of acute cellular rejection involves T-cell blockade with systemic corticosteroids. Antibody-mediated rejection treatment, on the other hand, entails the use of B-cell and antibody reduction therapies, such as intravenous immune globulin, plasmapheresis, and anti-CD20 monoclonal antibodies. Approaches to chronic rejection are even more varied, involving azithromycin, HMG coenzyme A reductase inhibitors, and extracorporeal photopheresis (a therapy in which a patient’s white blood cells undergo irradiation). Some special clinical scenarios, such as posttransplant lymphoproliferative disorder and posterior reversible encephalopathy syndrome, necessitate a reduction of maintenance immunosuppression.


Immunosuppression Renal failure Induction Systemic corticosteroids Maintenance immunosuppression Calcineurin inhibitor Antimetabolite therapy Acute cellular rejection Antibody-mediated rejection Chronic lung allograft dysfunction (CLAD) Posttransplant lymphoproliferative disorder (PTLD) Posterior reversible encephalopathy syndrome (PRES) 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.St. Louis Children’s HospitalSt. LouisUSA

Section editors and affiliations

  • Samuel B Goldfarb
    • 1
  1. 1.The Children's Hospital of PhiladelphiaPhiladelphiaUSA

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