Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland.
Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland.
Medicina (Kaunas). 2023 Mar 2;59(3):488. doi: 10.3390/medicina59030488.
Achieving adequate immunosuppression for lung transplant recipients in the first year after lung transplantation is a key challenge. Prophylaxis of allograft rejection must be balanced with the adverse events associated with immunosuppressive drugs, for example infection, renal failure, and diabetes. A triple immunosuppressive combination is standard, including a steroid, a calcineurin inhibitor, and an antiproliferative compound beginning with the highest levels of immunosuppression and a subsequent tapering of the dose, usually guided by therapeutic drug monitoring and considering clinical results, bronchoscopy sampling results, and additional biomarkers such as serum viral replication or donor-specific antibodies. Balancing the net immunosuppression level required to prevent rejection without overly increasing the risk of infection and other complications during the tapering phase is not well standardized and requires repeated assessments for dose-adjustments. In our adaptive immunosuppression approach, we additionally consider results from the white blood cell counts, in particular lymphocytes and eosinophils, as biomarkers for monitoring the level of immunosuppression and additionally use them as therapeutic targets to fine-tune the immunosuppressive strategy over time. The concept and its rationale are outlined, and areas of future research mentioned.
在肺移植后的第一年，为肺移植受者实现充分的免疫抑制是一个关键挑战。必须在同种异体移植排斥的预防与免疫抑制药物相关的不良反应之间取得平衡，例如感染、肾衰竭和糖尿病。三联免疫抑制组合是标准方案，包括类固醇、钙调磷酸酶抑制剂和抗增殖化合物，起始时使用最高水平的免疫抑制，随后逐渐减少剂量，通常通过治疗药物监测并考虑临床结果、支气管镜采样结果以及其他生物标志物，如血清病毒复制或供体特异性抗体来指导。在逐渐减少剂量的阶段，平衡预防排斥所需的净免疫抑制水平而不过度增加感染和其他并发症的风险尚未得到很好的标准化，需要反复评估以进行剂量调整。在我们的适应性免疫抑制方法中，我们还将白细胞计数（特别是淋巴细胞和嗜酸性粒细胞）的结果作为监测免疫抑制水平的生物标志物，并将其作为治疗靶点，随着时间的推移对免疫抑制策略进行微调。概述了该概念及其基本原理，并提到了未来的研究领域。
