Small Bronwyn, Au Jenny, Brink Heidi, Shah Ishani, Strah Heather
Department of Pulmonary, Critical Care of Sleep, University of Nebraska Medical Center, 985910 Nebraska Medical Center, Omaha, NE 68198-5910 USA.
Department of Pharmacy, Temple University Hospital, Philadelphia, PA USA.
Indian J Thorac Cardiovasc Surg. 2022 Jul;38(Suppl 2):300-317. doi: 10.1007/s12055-021-01225-x. Epub 2021 Sep 17.
Immunosuppression for lung transplant recipients is a critical part of post-transplant care, to prevent acute and chronic rejection. Treatment protocols consist of induction and maintenance immunotherapy. Induction agents provide an immediate state of immunosuppression following transplantation and over time, and their use has become more commonplace. Several agents are available for clinical use, including anti-thymocyte globulin, alemtuzumab, and basiliximab, the latter being most commonly employed. Each induction agent has unique side effects and caveats to their use, of which we must be aware. Maintenance immunosuppression is initiated following transplant but requires multiple doses prior to reaching therapeutic levels. A calcineurin inhibitor, an anti-metabolite, and a corticosteroid are traditionally used, most commonly tacrolimus, mycophenolate mofetil, and prednisone. Dosing regimens and goal trough levels vary and are tailored to a patient's clinical status and duration post-transplant. Future clinical studies may be able to assist in determining the optimal induction and maintenance immunosuppression regimens. In the interim, we use cohort and registry data to guide our therapies.
肺移植受者的免疫抑制是移植后护理的关键部分，用于预防急性和慢性排斥反应。治疗方案包括诱导免疫疗法和维持免疫疗法。诱导药物在移植后能立即提供免疫抑制状态，并随着时间推移发挥作用，其使用已变得更为普遍。有几种药物可用于临床，包括抗胸腺细胞球蛋白、阿仑单抗和巴利昔单抗，后者是最常用的。每种诱导药物都有独特的副作用和使用注意事项，我们必须对此有所了解。维持免疫抑制在移植后开始，但在达到治疗水平之前需要多次给药。传统上使用钙调神经磷酸酶抑制剂、抗代谢药物和皮质类固醇，最常用的是他克莫司、霉酚酸酯和泼尼松。给药方案和目标谷浓度各不相同，并根据患者的临床状况和移植后的时间进行调整。未来的临床研究或许能够帮助确定最佳的诱导和维持免疫抑制方案。在此期间，我们利用队列和登记数据来指导我们的治疗。
