The Evolution of Lung Transplant Immunosuppression

Advances in immunosuppression have been a key component to the ongoing success of lung transplantation. The demographics of patients receiving a lung transplant have evolved with older, more critically ill patients and those with previously contraindicated indications, now becoming recipients. Despite the lack of new classes of maintenance immunosuppression drugs becoming available, advances have been made in the prescribing of traditional immunosuppressive therapies. Developments in immunosuppressive regimens have seen changes in the route of administration, approaches to monitoring and combinations used. Long-term complications of immunosuppression, such as nephrotoxicity and malignancy can limit the success of lung transplantation, and strategies have evolved in recent years to minimise their long-term impact. Although survival outcomes have been steadily improving, chronic lung allograft dysfunction remains a barrier to long-term success. However, treatments for antibody-mediated rejection are emerging as a potential new therapeutic target to decrease the incidence of chronic lung allograft dysfunction. This article provides an update on the current status of immunosuppression after lung transplantation and reviews the evidence for immunosuppressive regimens and the implications for practice.