Induction therapy in lung transplantation

Sweet, Stuart C.

doi:10.1111/tri.12115

Cited by 27 publications

(10 citation statements)

References 53 publications

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“…Immunosuppressive protocols following lung transplantation must be modified to take into account certain organ-specific features. Maintaining adequate immunosuppression appears to be particularly important, especially during the immediate post-transplant period, due to various factors such as T-cell activation caused by donor dendritic cell activity and ongoing exposure of the lungs to endogenous antigens [ 162 ]. Acute rejection contributes to the risk of bronchiolitis obliterans syndrome (BOS) [ 163 ], the principal factor limiting long-term graft survival after lung transplantation [ 164 ].…”

Section: Ratg In Lung Transplantationmentioning

confidence: 99%

“…Retrospective analyses of data from the ISHLT registry have shown that induction therapy generally is associated with a reduced risk of BOS, presumably due to reduced rejection [ 162 , 166 , 167 ]. One analysis of ISHLT data [ 158 ] and one based on OPTN data [ 124 ] have indicated higher lung allograft and patient survival with induction versus no induction.…”

Section: Ratg In Lung Transplantationmentioning

confidence: 99%

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New Directions for Rabbit Antithymocyte Globulin (Thymoglobulin®) in Solid Organ Transplants, Stem Cell Transplants and Autoimmunity

Mohty

Bacigalupo

Saliba

et al. 2014

Drugs

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In the 30 years since the rabbit antithymocyte globulin (rATG) Thymoglobulin® was first licensed, its use in solid organ transplantation and hematology has expanded progressively. Although the evidence base is incomplete, specific roles for rATG in organ transplant recipients using contemporary dosing strategies are now relatively well-identified. The addition of rATG induction to a standard triple or dual regimen reduces acute cellular rejection, and possibly humoral rejection. It is an appropriate first choice in patients with moderate or high immunological risk, and may be used in low-risk patients receiving a calcineurin inhibitor (CNI)-sparing regimen from time of transplant, or if early steroid withdrawal is planned. Kidney transplant patients at risk of delayed graft function may also benefit from the use of rATG to facilitate delayed CNI introduction. In hematopoietic stem cell transplantation, rATG has become an important component of conventional myeloablative conditioning regimens, following demonstration of reduced acute and chronic graft-versus-host disease. More recently, a role for rATG has also been established in reduced-intensity conditioning regimens. In autoimmunity, rATG contributes to the treatment of severe aplastic anemia, and has been incorporated in autograft projects for the management of conditions such as multiple sclerosis, Crohn’s disease, and systemic sclerosis. Finally, research is underway for the induction of tolerance exploiting the ability of rATG to induce immunosuppresive cells such as regulatory T-cells. Despite its long history, rATG remains a key component of the immunosuppressive armamentarium, and its complex immunological properties indicate that its use will expand to a wider range of disease conditions in the future.

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Section: Ratg In Lung Transplantationmentioning

confidence: 99%

Section: Ratg In Lung Transplantationmentioning

confidence: 99%

New Directions for Rabbit Antithymocyte Globulin (Thymoglobulin®) in Solid Organ Transplants, Stem Cell Transplants and Autoimmunity

Mohty

Bacigalupo

Saliba

et al. 2014

Drugs

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“…In all three of our subjects, we observed decreases in CD4 levels early after transplantation. In general, IL-2 receptor antagonists, such as basilixumab, do not lead to significant T cell depletion (23). The drop in CD4 1 T cells may be due in part to mycophenolate mofetil (24).…”

Section: Original Researchmentioning

confidence: 99%

The Feasibility of Lung Transplantation in HIV-Seropositive Patients

et al. 2014

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“…In fact, clinical immunosuppression protocols depleting T cells indiscriminately in the peri-operative period that have been successful in kidney transplantation have been adapted to lung transplant patients (112). However, we have recently shown that graft infiltration by central memory CD8+ T cells is critical to induce costimulatory blockade-mediated tolerance after lung transplantation in the mouse (113).…”

Section: Introductionmentioning

confidence: 99%

Organ-specific differences in achieving tolerance

Madariaga¹,

Kreisel

Madsen

2015

Current Opinion in Organ Transplantation

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Purpose of review When it comes to tolerance induction, kidney allografts behave differently from heart allografts which behave differently from lung allografts. Here, we examine how and why different organ allografts respond differently to the same tolerance induction protocol. Recent findings Allograft tolerance has been achieved in experimental and clinical kidney transplantation. However, inducing tolerance in experimental recipients of heart and lung allografts has proven to be more challenging. New protocols being developed in nonhuman primates based on mixed chimerism and co-transplantation of tolerogenic organs may provide mechanistic insights to help overcome these challenges. Summary Tolerance induction protocols that are successful in patients transplanted with “tolerance-prone” organs such as kidneys and livers will most likely not succeed in recipients of “tolerance-resistant” organs such as hearts and lungs. Separate clinical trials using more robust tolerance protocols will be required to achieve tolerance in heart and lung recipients.

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Induction therapy in lung transplantation

Cited by 27 publications

References 53 publications

New Directions for Rabbit Antithymocyte Globulin (Thymoglobulin®) in Solid Organ Transplants, Stem Cell Transplants and Autoimmunity

New Directions for Rabbit Antithymocyte Globulin (Thymoglobulin®) in Solid Organ Transplants, Stem Cell Transplants and Autoimmunity

The Feasibility of Lung Transplantation in HIV-Seropositive Patients

Organ-specific differences in achieving tolerance

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