Evidence for immunosuppression in lung transplantation

Hopkins, Peter M. and McNeil, Keith (2008) Evidence for immunosuppression in lung transplantation. Current Opinion in Organ Transplantation, 13 5: 477-483. doi:10.1097/MOT.0b013e32831040bf

Author Hopkins, Peter M.
McNeil, Keith
Title Evidence for immunosuppression in lung transplantation
Journal name Current Opinion in Organ Transplantation   Check publisher's open access policy
ISSN 1087-2418
Publication date 2008-10
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/MOT.0b013e32831040bf
Volume 13
Issue 5
Start page 477
End page 483
Total pages 7
Place of publication Philadelphia, PA, U.S.A.
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Purpose of review: Historically, most lung transplant recipients have received triple-drug maintenance immunosuppression consisting of a calcineurin inhibitor, azathioprine, and prednisolone. The introduction of mycophenolate mofetil, mammalian target of rapamycin (mTOR) inhibitors, and antibody-based induction therapy has broadened immunosuppressive options. The purpose of this review is to summarize the evidence for immunosuppressive regimens in the prevention and treatment of lung allograft rejection.

Recent findings: In clinical practice there has been a shift towards the de-novo use of more potent immunosuppressive regimens incorporating tacrolimus and mycophenolate post-transplant. The available evidence, however, suggests that such protocols do not lessen the risk of development of chronic allograft rejection [bronchiolitis obliterans syndrome (BOS)] compared with more traditional therapy. The role of antibody-based induction therapy remains controversial, with no survival benefit demonstrated in trials to date. The mTOR inhibitors have marked antifibroproliferative activity and are being rigorously evaluated in large, multicenter, randomized trials focused on the prevention of both acute and chronic lung rejection.

Combination therapy with a calcineurin inhibitor, antimetabolite, and a corticosteroid derivative remains the backbone of lung transplant immunosuppression. Induction therapy (in whatever form) may reduce acute rejection, but does not lower the incidence of chronic rejection or improve survival. New strategies utilizing mTOR inhibitors may herald a more promising era.
Keyword Acute rejection
Lung transplantation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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