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.