Induction and maintenance immunosuppression in lung transplantation

Exploring Costimulatory Blockade-Based Immunologic Strategies in Transplantation: Are They a Promising Immunomodulatory Approach for Organ and Vascularized Composite Allotransplantation?

“…However, a biopsy is the investigation that ensures a definitive diagnosis. If confirmed, treatment is adjusted based on severity, using high-dose corticosteroids in mild to moderate cases [ 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 ]. Anti-thymocyte globulin may be used as a rescue strategy in corticosteroid-resistant or severe rejections [ 133 ].…”

Surgical Science and the Evolution of Critical Care Medicine

“…Basic and clinical inquiry advanced immune suppression from azathioprine to cyclosporine and currently tacrolimus (334). Regimens that guide the use of induction agents (e.g., antithymocyte globulin, alemtuzumab, and basiliximab), antirejection prophylaxis (e.g., glucocorticoid and mycophenolate mofetil), and antiinfection prophylaxis (e.g., trimethoprim-sulfamethoxazole) further improved outcomes (335). Metabolic investigations flourished during transplantation's early growth (336).…”

Lymphocyte Depleting and Modulating Therapies for Chronic Lung Allograft Dysfunction

“…1) Because of prolonged lymphodepletion, the potential for sustained bone marrow suppression is of concern, especially given the susceptibility of lung transplant recipients to infections and malignancies. (Trindade et al, 2020) Alemtuzumab has been used primarily for the treatment of chronic lymphocytic leukemia (Hallek, 2017) and relapsing-remitting multiple sclerosis (Syed, 2021), but also offlabel for induction immunosuppression in solid organ transplantation (Small et al, 2022).…”

“…ATG has been used in conditioning regimens for haematopoietic stem cell transplantation and as induction immunosuppression in solid organ transplants, including lung transplant recipients. (Mohty et al, 2014;Small et al, 2022) Common adverse events related to ATG include transfusion-related reactions, cytokine release syndrome, leukopenia, thrombocytopenia, and infections. (Mohty et al, 2014) Evidence in CLAD…”

“…(Huang et al, 2022) Basiliximab, a chimeric monoclonal antibody that selectively binds to the α-subunit (CD25) of interleukin-2 receptors, is used for induction therapy in lung transplantation. (Small et al, 2022) In addition, there are some case series describing its use in maintenance immunosuppression to avoid calcineurin inhibitor-related nephrotoxicity. (Högerle et al, 2016;Kim et al, 2021;Ross et al, 2020) Again, there is no data on any potential benefit in CLAD.…”