Skip to main content

Local Immunosuppression: The Lung

  • Chapter
Therapeutic Immunosuppression

Part of the book series: Immunology and Medicine Series ((IMME,volume 29))

  • 111 Accesses

Abstract

Lung transplantation represents an unusual situation in solid organ transplantation in that the graft is accessible to the external environment. In this situation aerosolized pharmacologic agents have direct access to the donor graft, and the technology for delivering medication by the inhalational route is well developed for other pulmonary disorders. In 1988, a team of investigators at the University of Pittsburgh made the decision to pursue aerosolized immunosuppression for lung transplant recipients based upon the belief that other limited models of localized immunosuppression have been successful, and the current pharmacologic regimen was not adequate for managing lung transplant rejection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Griffith BP, Paradis IL, Zeevi A, et al. Immunologically mediated disease of the airways after lung transplantation. Ann Surg 1988; 208:371.

    Article  PubMed  CAS  Google Scholar 

  2. Yousem SA, Berry GJ, Brunt EM, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Lung rejection study group. J Heart Lung Transplant 1990; 9:593.

    Google Scholar 

  3. Paradis I, Yousem S, Griffith BP. Airway obstruction and bronchiolitis obliterans after lung transplantation. Clin Chest Med 1993; 14:751.

    PubMed  CAS  Google Scholar 

  4. Cooper JD, Billingham M, Egan T, et al. C, Yousem S. A working formulation for nomenclature and for clinical staging of chronic dysfunction in lung allografts. J Heart Lung Transplant 1993; 12:713.

    PubMed  CAS  Google Scholar 

  5. Zenati M, Duncan AJ, Burckart GJ, et al. Immunosuppression with aerosolized cyclosporin for prevention of lung rejection in a rat model. Eur J Cardiothorac Surg 1991; 5:266.

    Article  PubMed  CAS  Google Scholar 

  6. Trulock EP. Management of lung transplant rejection. Chest 1993; 103:1566.

    Article  PubMed  CAS  Google Scholar 

  7. Bando K, Paradis IL, Konishi H, et al. Obliterative bronchiolitis after lung and heart-lung transplantation: an analysis of risk factors and management. J Thoracic Cardiovas Surg 1995;110:4–13.

    Article  CAS  Google Scholar 

  8. Glanville GR, Baldwin JC, Burke CM, Theodure J, Robin E. Obliterative bronchiolitis after heart-lung transplantation: apparent arrest by augmented immunosuppression. Ann Int Med 1987; 107:300.

    PubMed  CAS  Google Scholar 

  9. Theodure J, Starnes VA, Lewiston NJ. Obliterative bronchiolitis. Clin Chest Med 1990; 11:309.

    Google Scholar 

  10. Kahan BD. Cyclosporine. N Engl J Med 1989; 321:1725.

    Article  PubMed  CAS  Google Scholar 

  11. Ascher NL, Chen S, Hofman RA, Simmons RL. Maturation of cytotoxic T-cells within sponge matrix allograft. J Immunol 1983; 131.

    Google Scholar 

  12. Wolf JS, McGavic JD, Hume DM. Inhibition of the effector mechanism of transplant immunity by local graft irradiation. Surg Gynecol Obstet 1969; 128:584

    PubMed  CAS  Google Scholar 

  13. Gergely NF, Coles JC. Prolongation of heterotopic cardiac allografts in dogs by topical irradiation. Transplantation 1970; 9:193.

    Article  PubMed  CAS  Google Scholar 

  14. Fidler JP, Alexander JW, Smith EJ, Miller HC, Muthiah V. Radiation reversal of acute rejection in patients with life threatening infection. Arch Surg 1973; 107:256.

    Article  PubMed  CAS  Google Scholar 

  15. Ruers TJM, Buurman WA, van der Linden CJ, Kootstra G. Local inhibition of major histocompatibility complex class n induction within the graft: an effective way to induce immunosuppression. Transplant Proc 1987; 19:246.

    PubMed  CAS  Google Scholar 

  16. Ruers T, Daemen M, Thijssen H, van der Linden C, Buurman W. Sensitivity of graft rejection in rats to local immunosuppressive therapy. Transplantation 1988; 46:820.

    Article  PubMed  CAS  Google Scholar 

  17. Stepkowski SM, Goto S, Ito T. et al. Prolongation of heterotopic heart allograft survival by local delivery of continuous low-dose cyclosporine therapy. Transplantation 1989; 47:17.

    Article  PubMed  CAS  Google Scholar 

  18. Burckart GJ, Dowling R, Zenati M, Yousem SA, Venkataramanan R, Griffith BP. Cyclosporine administration by aerosol. J Clin Pharmacol 1989; 29:832–62.

    Google Scholar 

  19. Dowling RD, Zenati M, Burckart GJ, Yousem SA, Schaper M, Hardesty RL, Griffith BP: Aerosolized cyclosporine as single agent immunotherapy in canine lung allografts. Surgery 1990; 108:198–205.

    PubMed  CAS  Google Scholar 

  20. Keenan RJ, Duncan AJ, Yousem SA, Zenati M, Schaper M, Dowling RD, Alarie Y, Burckart GJ, Griffith BP: Improved immunosuppression with aerosolized cyclosporine in experimental pulmonary transplantation. Transplantation 1992; 53:20–5.

    Article  PubMed  CAS  Google Scholar 

  21. Muggenburg BA, Hoover MD, Griffith BP, Haley PJ, Snipes MB, Wolff RK, Yeh HC, Burckart GJ, Mauderly JL: Administration of cyclosporine by aerosol: A feasibility study in beagle dogs. J Aerosol Med 1990; 3:1–13.

    Article  Google Scholar 

  22. Mitruka SN, Pham SM, Zeevi A, Li S, Cai J, Burckart GJ, Yousem SA, Keenan RJ, Griffith BP. Aerosol Ciclosporine prevents acute allograft rejection in experimental lung transplantation. Journal of Thoracic and Cardiovascular Surgery 1998; 115: 28–37.

    Article  PubMed  CAS  Google Scholar 

  23. O’Riordan TG, Duncan SR, Burckart GJ, Griffith BP, Smaldone GC: Production of an aerosol of Ciclosporine as a prelude to clinical studies. J Aerosol Med 1992; 5: 171–177.

    Article  Google Scholar 

  24. O’Riordan TG, Iacono A, Keenan RJ, Duncan SR, Burckart GJ, Griffith BP, Smaldone GC. Delivery and distribution of aerosolized Ciclosporine in lung allograft recipients. Am J Resp Crit Care Med 1995; 151:516–21.

    PubMed  Google Scholar 

  25. Iacono A, Keenan RJ, Duncan SR, Smaldone GC, Dauber JH, Paradis IL, Ohori NP, Grgurich WF, Burckart GJ, Zeevi A, Delgado E, O’Riordan TG, Zendarsky MM, Yousem SA, Griffith BP: Aerosolized Ciclosporine in lung recipients with refractory chronic rejection. Am J Resp Crit Care Med 1996; 153: 1451–1455.

    PubMed  CAS  Google Scholar 

  26. Iacono A, Dauber J, Keenan R, Spichty K, Cai J, Grgurich W, Burckart G, Smaldone G, Pham S, Ohori NP, Yousem S, Griffith B, Zeevi A. Interleukin-6 and interferon-γ gene expression in lung transplant recipients with refractory acute cellular rejection: implications for monitoring and inhibition by treatment with aerosolized Cyclosporine. Transplantation 1997; 64:263–269.

    Article  PubMed  CAS  Google Scholar 

  27. Dhanjal U, Dauber J, Grgurich W, Raghu S, Keenan R, McCurry K, Griffith B, Smaldone G, Burckart G, Iacono A. Use of aerosol Cyclosporine for refractory rejection in lung transplant patients. Am J Respir Crit Care Med 1999; 159:A279.

    Google Scholar 

  28. Iacono et.al. Aerosolized Cyclosporine Given as Prophylaxis for Acute Rejection After Lung Transplantation: Safety and Peripheral Lung Deposition Following Early Administration. Am. J. of Resp. and Crit. Care Med., 157:3; 328.

    Google Scholar 

  29. Akutsu I, Fukuda T, Majima K, Makino S. Inhibitory effect of inhaled FK-506 on increased bronchial responsiveness and eosinophil infiltration in the airway mucosa. Arerugi 1992; 41: 543–547.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Iacono, A.T., Burckart, G.J., Zeevi, A., Kunter, E., Griffith, B.P. (2001). Local Immunosuppression: The Lung. In: Thomson, A.W. (eds) Therapeutic Immunosuppression. Immunology and Medicine Series, vol 29. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-0765-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-94-010-0765-8_13

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3821-8

  • Online ISBN: 978-94-010-0765-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics