Maintenance Immunosuppression in Adult Lung Transplant Recipients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Lung transplantation is a definitive therapeutic option for selected patients with advanced pulmonary diseases. However, long-term outcomes remain suboptimal, largely driven by immunologically mediated complications, including acute rejection and chronic lung allograft dysfunction, as well as the cumulative toxicity of lifelong immunosuppression. This study was conducted as a systematic review and meta-analysis in accordance with PRISMA recommendations. A comprehensive search of PubMed, Embase, and the Cochrane Library was performed from inception. Randomized controlled trials evaluating maintenance immunosuppressive regimens in adult lung transplant recipients were included. When appropriate, treatment effects were pooled using random-effects models and are reported as risk ratios (RR) with 95