Review article
Immunosupressive therapy in the lung transplant recipient
Gordana Pavliša
Andrea Vukić Dugac
Peter Jaksch
Miroslav Samaržija
Abstract
Lung transplantation has become a life-saving procedure for individuals with variety of end-stage respiratory diseases. Optimal immunosuppression remains the key to long-term graft survivival. The protocols for immunosuppressive therapy following lung transplantation can be divided into three general categories: induction, maintenance, and treatment of rejection. The goal of induction therapy is to provide intense immunosuppression in the early post-transplantation period, when the risk of allograft rejection is the highest. Induction agents primarily target T lymphocytes, which are considered the effector cells in cell-mediated rejection. Current maintenance therapy typically includes a calcineurin inhibitor, nucleotide blocking agent and corticosteroid. Pulse steroids are generally the first treatment of acute cellular rejection. Therapeutic modalities for treatment of refractory cellular rejection include switch from cyclosporine to tacrolimus, use of lymphocyte depleting agents, azithromycine, and extracorporeal photopheresis. Treatment options for humoral rejections include plasmapheresis and immunoglobulines in combination with rituximab.
Keywords
lung transplantation; immunosuppression; induction therapy; maintenance therapy; rejection
Hrčak ID:
139007
URI
Publication date:
14.5.2015.
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