Overview of Transplantation Immunology and the Pharmacotherapy of Adult Solid Organ Transplant Recipients: Focus on Immunosuppression

Abstract

A review of transplantation immunology is discussed with emphasis on alloantigen presentation, T-lymphocyte activation and proliferation, and the immune effector mechanisms responsible for allograft rejection. Immunosuppressive pharmacology is introduced beginning with conventional medications (cyclosporine, azathioprine, and corticosteroids) followed by a discussion of drugs recently approved by the US Food and Drug Administration (mycophenolate mofetil, tacrolimus, and the interleukin-2 receptor antagonists). In addition, drugs that are used in the treatment of transplant rejection or as rescue therapy are discussed (muromonab-CD3, antithymocyte globulin, mycophenolate mofetil, tacrolimus, and corticosteroids). Throughout, implications for nurses involved in the pharmacotherapy of transplant recipients are discussed.

Review on immunosuppression in liver transplantation

“…However, the risk of organ rejection may increase following early corticosteroid dose reduction or withdrawal [17] . Usually, a calcineurin inhibitors (CNI), alone or with an anti-proliferative agent mycophenolic acid (MPA) or azathioprine is started early post transplantation in combination with a corticosteroid to help maintain immunosuppression [18] . More recently, antibody therapies have been combined with corticosteroids or used to facilitate "steroidfree" regimens.…”

Delta-Like Canonical Notch Ligand 1 in Patients Following Liver Transplantation—A Secondary Analysis of a Prospective Cohort Study

“…Endothelial cells as well as monocytes are claimed to secret relevant amounts of DLL1 [28]. Patients following LTX need immunosuppressive drugs in order to avoid an acute rejection [29,30]. Within our collective corticosteroids, mycophenolate mofetil and the calcineurin inhibitors (CNI) cyclosporine or tacrolimus were used for immunosuppression.…”

Approach to Imaging Pulmonary Disease in the Immune Compromised Host

“…Other drugs such as cyclosporine, azathioprine, mycophenolate, tacrolimus, antitumor necrosis factor antibodies, and antilymphocyte antibodies block various specific pathways required for lymphocyte activation. 2,3 Inborn diseases that compromise barriers to infection such as immotile cilia syndrome and cystic fibrosis also make up an important group of patients with immune deficiencies. In the adult population, however, it is more common to encounter acquired immunodeficiencies.…”