Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol
Achieving adequate immunosuppression for lung transplant recipients in the first year after lung transplantation is a key challenge. Prophylaxis of allograft rejection must be balanced with the adverse events associated with immunosuppressive drugs, for example infection, renal failure, and diabetes...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/59/3/488 |
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| author | Macé M. Schuurmans Miro E. Raeber Maurice Roeder René Hage |
| author_facet | Macé M. Schuurmans Miro E. Raeber Maurice Roeder René Hage |
| author_sort | Macé M. Schuurmans |
| collection | DOAJ |
| description | Achieving adequate immunosuppression for lung transplant recipients in the first year after lung transplantation is a key challenge. Prophylaxis of allograft rejection must be balanced with the adverse events associated with immunosuppressive drugs, for example infection, renal failure, and diabetes. A triple immunosuppressive combination is standard, including a steroid, a calcineurin inhibitor, and an antiproliferative compound beginning with the highest levels of immunosuppression and a subsequent tapering of the dose, usually guided by therapeutic drug monitoring and considering clinical results, bronchoscopy sampling results, and additional biomarkers such as serum viral replication or donor-specific antibodies. Balancing the net immunosuppression level required to prevent rejection without overly increasing the risk of infection and other complications during the tapering phase is not well standardized and requires repeated assessments for dose-adjustments. In our adaptive immunosuppression approach, we additionally consider results from the white blood cell counts, in particular lymphocytes and eosinophils, as biomarkers for monitoring the level of immunosuppression and additionally use them as therapeutic targets to fine-tune the immunosuppressive strategy over time. The concept and its rationale are outlined, and areas of future research mentioned. |
| first_indexed | 2024-03-11T06:12:54Z |
| format | Article |
| id | doaj.art-f441d04d34cd4c76885318d52342a601 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T06:12:54Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-f441d04d34cd4c76885318d52342a6012023-11-17T12:31:21ZengMDPI AGMedicina1010-660X1648-91442023-03-0159348810.3390/medicina59030488Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich ProtocolMacé M. Schuurmans0Miro E. Raeber1Maurice Roeder2René Hage3Division of Pulmonology, University Hospital Zurich, 8091 Zurich, SwitzerlandFaculty of Medicine, University of Zurich, 8032 Zurich, SwitzerlandDivision of Pulmonology, University Hospital Zurich, 8091 Zurich, SwitzerlandDivision of Pulmonology, University Hospital Zurich, 8091 Zurich, SwitzerlandAchieving adequate immunosuppression for lung transplant recipients in the first year after lung transplantation is a key challenge. Prophylaxis of allograft rejection must be balanced with the adverse events associated with immunosuppressive drugs, for example infection, renal failure, and diabetes. A triple immunosuppressive combination is standard, including a steroid, a calcineurin inhibitor, and an antiproliferative compound beginning with the highest levels of immunosuppression and a subsequent tapering of the dose, usually guided by therapeutic drug monitoring and considering clinical results, bronchoscopy sampling results, and additional biomarkers such as serum viral replication or donor-specific antibodies. Balancing the net immunosuppression level required to prevent rejection without overly increasing the risk of infection and other complications during the tapering phase is not well standardized and requires repeated assessments for dose-adjustments. In our adaptive immunosuppression approach, we additionally consider results from the white blood cell counts, in particular lymphocytes and eosinophils, as biomarkers for monitoring the level of immunosuppression and additionally use them as therapeutic targets to fine-tune the immunosuppressive strategy over time. The concept and its rationale are outlined, and areas of future research mentioned.https://www.mdpi.com/1648-9144/59/3/488lung transplantationimmunosuppressiontherapeutic drug monitoringlymphocyteseosinophils |
| spellingShingle | Macé M. Schuurmans Miro E. Raeber Maurice Roeder René Hage Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol Medicina lung transplantation immunosuppression therapeutic drug monitoring lymphocytes eosinophils |
| title | Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol |
| title_full | Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol |
| title_fullStr | Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol |
| title_full_unstemmed | Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol |
| title_short | Adaptive Immunosuppression in Lung Transplant Recipients Applying Complementary Biomarkers: The Zurich Protocol |
| title_sort | adaptive immunosuppression in lung transplant recipients applying complementary biomarkers the zurich protocol |
| topic | lung transplantation immunosuppression therapeutic drug monitoring lymphocytes eosinophils |
| url | https://www.mdpi.com/1648-9144/59/3/488 |
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