Choice of Medications for Lung Transplantation

Immunosuppressive therapy in lung transplantation is an intricate negotiation among pharmacotherapy to prevent allograft rejection and infection, adverse effects, and malignancy. In the case of lung transplantation particularly, infection and rejection are experienced at higher rates than other transplanted organs. Further adding to the complexity of pharmacotherapy is the fact that FDA-approved indications and established consensus do not currently exist to allow for standardized immunosuppressive regimens. Pharmacological approaches for immunosuppression in lung transplant have primarily been brought forward from other transplant indications. With respect to lung transplant-specific data, the foundation is limited to smaller studies, empirical approaches from single-center experience. Triple-drug therapy is the predominant approach consisting of a calcineurin inhibitor, antiproliferative agent, and corticosteroid. Alloimmune and autoimmune responses are thought to contribute to chronic lung allograft dysfunction, which is the primary focus for long-term survival post-transplant. While increased survival has resulted from advances in therapies, novel approaches to treat rejection focus on emerging antibody-mediated rejection and chronic lung allograft dysfunction therapies and emerging thoughts are to target specific pathways of the alloimmune response. As such, intracellular targets through activation pathways of T cells and B cells are of focus. These include protein kinase C inhibitors, Janus-associated kinase inhibitors, and proteasome inhibitors.