47 UDK 616.24-089.843 Review article Received: 23 March 2015 Accepted: 15. April 2015 IMMUNOSUPRESSIVE THERAPY IN THE lUNG TRANSPlANT RECIPIENT Gordana Pavliša 1,2 , Andrea Vukić Dugac 1 , Peter Jaksch 3 , Miroslav Samaržia 1,2 1 Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb; 2 University of Zagreb, School of Medicine; Zagreb, Croatia; 3 University Hospital AKH Vienna, Austria Summary Lung transplantation has become a life-saving procedure for individuals with variety of end-stage respiratory diseases. Optimal immunosuppression remains the key to long-term graft survivival. The protocols for immunosuppressive therapy following lung transplantation can be divided into three general categories: induction, maintenance, and treatment of rejection. The goal of induction therapy is to provide intense immunosuppression in the early post-transplan- tation period, when the risk of allograft rejection is the highest. Induction agents primarily tar- get T lymphocytes, which are considered the effector cells in cell-mediated rejection. Current maintenance therapy typically includes a calcineurin inhibitor, nucleotide blocking agent and corticosteroid. Pulse steroids are generally the frst treatment of acute cellular rejection. Therape- utic modalities for treatment of refractory cellular rejection include switch from cyclosporine to tacrolimus, use of lymphocyte depleting agents, azithromycine, and extracorporeal photophere- sis. Treatment options for humoral rejections include plasmapheresis and immunoglobulines in combination with rituximab. Keywords: lung transplantation; immunosuppression; induction therapy; maintenance the- rapy; rejection. INTRODUCTION Lung transplantation has become a life-saving procedure for individuals with variety of end-stage respiratory diseases. The success of transplantation has been closely related to descovery of efective imunosuppressive regimens. In the early 1980s, the introduction of ciclosporin as the mainstay of maintenace immunosu- ppression was followed by a signifcant improvement in the survival of lung tran-