Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA.
Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Handb Exp Pharmacol. 2022;272:139-164. doi: 10.1007/164_2021_548.
Immunosuppression in lung transplantation is an area devoid of robust clinical data. This chapter will review the history of immunosuppression in lung transplantation. Additionally, it will evaluate the three classes of induction, maintenance, and rescue immunosuppression in detail. Induction immunosuppression in lung transplantation aims to decrease incidence of lung allograft rejection, however infectious risk must be considered when determining if induction is appropriate and which agent is most favorable. Similar to other solid organ transplant patient populations, a multi-drug approach is commonly prescribed for maintenance immunosuppression to minimize single agent drug toxicities. Emphasis of this review is placed on key medication considerations including dosing, adverse effects, and drug interactions. Clinical considerations will be reviewed per drug class given available literature. Finally, acute cellular, antibody mediated, and chronic rejection are reviewed.
肺移植中的免疫抑制是一个缺乏可靠临床数据的领域。本章将回顾肺移植中免疫抑制的历史。此外，它将详细评估诱导、维持和挽救免疫抑制的三类药物。肺移植中的诱导免疫抑制旨在降低肺移植物排斥反应的发生率，但在确定诱导是否合适以及哪种药物最有利时，必须考虑感染风险。与其他实体器官移植患者群体一样，维持免疫抑制通常采用多药物治疗方法，以最大程度地减少单一药物的毒性。本综述的重点是药物剂量、不良反应和药物相互作用等关键药物注意事项。根据现有文献，对每个药物类别进行临床注意事项的审查。最后，回顾急性细胞、抗体介导和慢性排斥反应。
