Burcham Pamela, Sarzynski Lisa, Khalfoun Sabrina, Novak Kimberly J, Miller Julie C, Tumin Dmitry, Hayes Don
Department of Pharmacy, The Ohio State University, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
Paediatr Drugs. 2017 Aug;19(4):339-346. doi: 10.1007/s40272-017-0236-2.
Cystic fibrosis (CF) is a common indication for lung transplantation (LTx) in children and adults with severe and irreversible lung disease. In the setting of LTx in the CF population, immunosuppressive medications are used to prevent allograft rejection despite the majority of these patients being chronically infected with numerous, and often antibiotic-resistant, pathogens. There is limited evidence for the optimal post-LTx immunosuppression regimen in patients with CF, particularly in children. This article provides a review of immunosuppression regimens in the pediatric and adult CF post-LTx population, investigating drug dosing and monitoring, and medication combinations. Currently used immunosuppressive medications and related systemic adverse effects are reviewed. With limitations of data in the pediatric population, future research should address immunosuppression in these children to help guide pediatric drug management as a means to optimize clinical outcomes after LTx.
囊性纤维化（CF）是患有严重且不可逆肺部疾病的儿童和成人进行肺移植（LTx）的常见适应症。在CF人群进行肺移植的情况下，尽管这些患者中的大多数长期感染多种且通常具有抗生素耐药性的病原体，但仍使用免疫抑制药物来预防同种异体移植排斥反应。关于CF患者肺移植后最佳免疫抑制方案的证据有限，尤其是在儿童中。本文综述了儿童和成人CF肺移植后人群的免疫抑制方案，研究了药物剂量、监测及药物组合。对目前使用的免疫抑制药物及其相关的全身性不良反应进行了综述。鉴于儿科人群数据的局限性，未来的研究应关注这些儿童的免疫抑制情况，以帮助指导儿科药物管理，作为优化肺移植后临床结局的一种手段。
