Immunosuppressive drugs and novel strategies to prevent acute and chronic allograft rejection.

Maintenance immunosuppression for lung transplantation includes cyclosporine or tacrolimus, mycophenolate mofetil or azathioprine, and prednisone. Some centers rely on induction agents including OKT3 (murine monoclonal antibody, OKT3), ATG (antithymocyte globulin), or thymoglobulin. In addition, a number of new agents including sirolimus (SRL) and the interleukin (IL)-2 receptor antagonists, daclizumab and basiliximab, have become available. Management of chronic rejection typically consists of augmented immunosuppression using many of the standard agents, and other potent agents such as methotrexate or cytoxan or more novel strategies including photopheresis, radiation, and total lymphoid irradiation (TLI).