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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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New frontiers in immunosuppression.

Luke J Benvenuto1, Michaela R Anderson1, Selim M Arcasoy1

  • 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, USA.

Journal of Thoracic Disease
|July 13, 2018
PubMed
Summary
This summary is machine-generated.

Immunosuppressive therapy is crucial after lung transplantation to prevent rejection and improve graft function. Balancing efficacy with side effects, current strategies focus on induction, maintenance, and managing antibody formation for better patient outcomes.

Keywords:
Inductiondesensitizationimmune toleranceimmunosuppressionmaintenance

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Area of Science:

  • Immunology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Immunosuppressive therapy is vital post-lung transplantation, aiming to prevent rejection and optimize long-term allograft function.
  • Balancing immunosuppression benefits against medication toxicities is a critical clinical challenge.
  • Current immunosuppressive regimens, including induction and maintenance therapies, face limitations in improving chronic outcomes and managing antibody-related complications.

Purpose of the Study:

  • To review current immunosuppressive medications used in lung transplantation, detailing their efficacy and side effect profiles.
  • To explore strategies for HLA desensitization before and management of de novo antibody formation after lung transplantation.
  • To discuss the potential of immune tolerance as a future approach to mitigate conventional immunosuppressive therapy toxicities.

Main Methods:

  • Review of literature on immunosuppressive agents for lung transplantation.
  • Analysis of efficacy and side effect profiles of induction and maintenance therapies.
  • Examination of strategies for HLA antibody management and immune tolerance.

Main Results:

  • Induction therapy, while controversial, is widely used; maintenance regimens combining glucocorticoids, calcineurin inhibitors, and anti-metabolites show modest improvements.
  • HLA antibodies, both pre-existing and de novo, present significant therapeutic challenges.
  • Limited improvements in chronic maintenance immunosuppression highlight the need for novel strategies.

Conclusions:

  • Optimizing immunosuppression in lung transplantation requires careful consideration of drug efficacy, toxicity, and antibody management.
  • Strategies for HLA desensitization and managing de novo antibodies are crucial for successful transplantation.
  • Future research into immune tolerance holds promise for reducing the long-term toxicities associated with current immunosuppressive protocols.