Pharmacology Notes

Over the past 20 years, the success of lung transplantation for end-stage respiratory disease has depended upon development of effective immunosuppression. The introduction from the early 1980s of cyclosporin (a calcineurin antagonist) in combination with azathioprine (a cell cycle inhibitor) and a corticosteroid revolutionised outcomes. The current prognosis after lung transplantation is not as good as for other solid organ allografts, but a survival of over 80% at 1 year, and over 50% at 5 years can now be expected as a result of therapeutic advances.

Early deaths are usually related to infection and to a lesser extent acute rejection, while later deaths are usually related to infection or bronchiolitis obliterans syndrome. Malignancy, renal failure and other organ failure secondary to immunosuppressive medication also play a part in late mortality.