Chandrashekaran Satish, Crow Pharm Stacy A, Shah Sadia Z, Arendt Pharm Chris J, Kennedy Cassie C
Division of Pulmonary, Critical Care and Sleep Medicine, Lung Transplantation Program, University of Florida Gainesville, FL.
Pharmacy Services, Mayo Clinic, Rochester, MN.
Curr Transplant Rep. 2018 Sep;5(3):212-219. doi: 10.1007/s40472-018-0199-4. Epub 2018 Jul 13.
The number of lung transplantations performed worldwide continues to increase. There is a growing need in these patients for more effective immunosuppressive medications with less toxicity.
This review article summarizes the recent studies and developments in lung transplant immunosuppression. Novel immunosuppressive medications and strategies used in other solid organ transplantations are being trialed in lung transplantation. This includes the use of co-stimulation blockers like belatacept and mTOR inhibitors like everolimus. Calcineurin sparing regimens have been described in an attempt to minimize nephrotoxicity. Assays to measure the bioactivity of immunosuppressive medications to determine the global immune competence, such as Immuknow assay and Gamma interferon response are gaining traction.
Immunosuppression in lung transplant is evolving with the development of newer drugs and promising strategies to optimize immunosuppression. Further studies with multicenter randomized trials are required to increase the strength of the evidence.
全球范围内进行的肺移植数量持续增加。这些患者对毒性更小的更有效免疫抑制药物的需求日益增长。
本文综述总结了肺移植免疫抑制方面的最新研究与进展。其他实体器官移植中使用的新型免疫抑制药物和策略正在肺移植中进行试验。这包括使用如贝拉西普等共刺激阻滞剂和依维莫司等mTOR抑制剂。为尽量减少肾毒性，已描述了钙调神经磷酸酶 sparing 方案。用于测量免疫抑制药物生物活性以确定整体免疫能力的检测方法，如免疫状态监测分析（Immuknow assay）和γ干扰素反应，正越来越受到关注。
随着更新药物的开发以及优化免疫抑制的有前景策略的出现，肺移植中的免疫抑制正在不断发展。需要进行更多多中心随机试验研究以增强证据力度。
