title: Immunosuppression and allograft rejection following lung transplantation: evidence to date.
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.
authors.affiliation: Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, VIC, Australia, g.snell@alfred.org.au.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Snell
authors.forename: Glen P
authors.initials: GP
authors.lastname: Westall
authors.forename: Miranda A
authors.initials: MA
authors.lastname: Paraskeva
mesh_terms: D064591:Allografts / Q000187:drug effects*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents