Chronic allograft rejection: epidemiology, diagnosis, pathogenesis, and treatment

Semin Respir Crit Care Med. 2010 Apr;31(2):189-207. doi: 10.1055/s-0030-1249116. Epub 2010 Mar 30.


Lung transplantation is a therapeutic option for patients with end-stage pulmonary disorders. Unfortunately, chronic lung allograft rejection, in the form of obliterative bronchiolitis and its clinical correlate bronchiolitis obliterans syndrome (BOS), continues to be highly prevalent and is the major limitation to long-term survival. The pathogenesis of BOS is complex and involves alloimmune and nonalloimmune pathways. The airway obstruction involved is classically progressive and unresponsive to treatment; however, the course is highly variable, and distinguishable phenotypes may exist. A better understanding of the risk factors and their relationship to the pathological mechanisms of chronic lung allograft rejection should lead to better pharmacological targets to prevent or treat this syndrome.

Publication types

  • Review

MeSH terms

  • Bronchiolitis Obliterans / immunology
  • Graft Rejection / diagnosis*
  • Graft Rejection / therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Lung Transplantation / immunology*
  • Tissue Donors


  • Immunosuppressive Agents