Long term survival and quality of life after lung transplantation are still affected by the development of
chronic lung graft dysfunction (CLAD). CLAD is the number one cause of death one year after transplant; and
there is no effective therapy available to date. Transplant centers’ approaches include perioperative immunosuppression,
maintenance immunosuppression, and the treatment of eventual rejection. This review will focus on
maintenance immunosuppression and the available data that support these strategies, as well as a brief description
of our desensitization protocol and immunologic risk stratification. Optimization of immunosuppression is key to
increase survival and graft function in transplant recipients, mostly through the combination of drugs. Since the
therapeutic options to manage CLAD are still very limited, more studies are necessary to test new therapies and to
clarify the potential role of new agents.
Keywords: Lung transplantation, chronic lung graft dysfunction, review, immunosuppression, risk stratification, transplant.
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