Immunosuppression in Lung Transplantation: Current and Emerging Therapies

Abstract Purpose of Review Lung transplantation is a growing field in the treatment of end stage lung disease. However, median survival in lung transplant remains lower than in other solid organs due to rejection. Immunosuppression is one of the few ways to mitigate this risk, but institutional practice patterns vary widely. We describe the most used immunosuppressive agents and share our center experiences. Recent Findings Immunosuppression is achieved in two ways: induction and maintenance. Induction agents include basiliximab, anti-thymocyte globulin, and alemtuzumab. Maintenance immunosuppression includes calcineurin inhibitors, antiproliferative agents and corticosteroids. Mammalian target of rapamycin inhibitors should be used cautiously. Belatacept and basiliximab are both emerging agents for maintenance immunosuppression. Summary Immunosuppression is mandatory for the success of lung transplantation. Although some advancements have been made in these therapies, more randomized-controlled trials are needed to determine what agents, doses and combinations should be used.