What is included in immunotherapy maintenance following lung transplantation?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Maintenance therapy with a triple-drug regimen is still the conventional practice for lung transplantation. The first-line treatment of an episode of acute rejection is high-dose intravenous steroid pulses. For ongoing or recurrent acute rejection, the strategy is to add rapamycin. The second choice for refractory acute rejection is treatment with antithrombocyte globulin (ATG) or OKT3. In refractory cases, high-dose intravenous immune globulin can be used.

For treatment of chronic rejection, which is referred to as bronchiolitis obliterans syndrome, the most difficult issue following lung transplantation remains unsettled. Patients whose regimen includes cyclosporine should be switched to tacrolimus from cyclosporine. For patients unresponsive to the change to tacrolimus from cyclosporine, high-dose steroid pulses and ATG are still frequently used. Rapamycin may also be introduced as a fourth agent. Other possible therapies are total lymphoid irradiation and photopheresis, which are really last resorts.

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