Abstract
Outcomes after lung transplantation remain disappointing because there is a high incidence
of chronic lung allograft dysfunction (CLAD), which typically follows a progressive
clinical course and often results in allograft failure and death. Chronic rejection
is considered the predominant cause of CLAD. Thus, optimal immunosuppression has been
viewed as having the potential to prevent CLAD and improve survival after lung transplantation.
Numerous clinical trials have been conducted investigating the efficacy and safety
of various immunosuppressive agents. Many studies have been small and single-center
clinical trials but some have been international and multicenter trials enrolling
more than 300 patients. This review focuses on clinical trials of immunosuppression
conducted in lung transplantation and points out strengths and limitations of the
various studies. Ultimately, the findings of these clinical trials explain the current
state of practice in lung transplantation and identify gaps in knowledge that require
additional study. Finally, there is an ongoing need for carefully designed and conducted
clinical trials to improve clinical practice and outcomes after lung transplantation.
Keywords
lung transplantation - acute rejection - immunosuppression - bronchiolitis obliterans
syndrome - chronic lung allograft dysfunction
