Lung allograft rejection: diagnosis and management

Curr Opin Organ Transplant. 2009 Oct;14(5):477-82. doi: 10.1097/MOT.0b013e32832fb981.


Purpose of review: Rejection remains a common complication after lung transplantation and has adversely affected long-term outcomes. This manuscript reviews the various manifestations of rejection after lung transplantation and provides an update of recent developments.

Recent findings: The grading scheme for lymphocytic bronchiolitis was updated in 2007, and recent studies demonstrate that this disease is an important and independent risk factor for chronic rejection. Furthermore, a role for humoral immunity has become more apparent in recent years, although this role remains enigmatic in lung transplantation. Finally, a new subtype of bronchiolitis obliterans syndrome, termed neutrophilic reversible allograft dysfunction, has been proposed based on the response to treatment with azithromycin.

Summary: Acute rejection and lymphocytic bronchiolitis are major risk factors for chronic rejection, which remains the primary obstacle to better outcomes after lung transplantation.

Publication types

  • Review

MeSH terms

  • Biopsy
  • Bronchiolitis / complications
  • Bronchiolitis / diagnosis
  • Bronchiolitis / drug therapy
  • Glucocorticoids / therapeutic use*
  • Graft Rejection* / diagnosis
  • Graft Rejection* / drug therapy
  • Graft Rejection* / etiology
  • Humans
  • Immunity, Humoral / immunology*
  • Immunosuppressive Agents / therapeutic use*
  • Lung Transplantation*
  • Prognosis
  • Transplantation, Homologous


  • Glucocorticoids
  • Immunosuppressive Agents