Detection, classification, and management of rejection after lung transplantation

Despite advances in surgical techniques and recipient and donor selection, survival following lung transplantation remains worse compared with other solid organ transplantation with a median survival of 6 years (1). Graft failure is responsible for 22.7% of deaths between 30 days and 1 year following transplant. After the first year, chronic lung allograft dysfunction (CLAD) is the leading cause of death. Multiple factors likely contribute to high rates of rejection following lung transplantation, including increased susceptibility of the lung to injury and infection as well as constant environmental exposure (2). This article will review the clinical and pathologic features of and treatment options for acute cellular rejection (ACR), acute airway rejection, antibody-mediated rejection (AMR), and CLAD