Acute Cellular Rejection

Acute cellular rejection (ACR) is a common complication following lung transplantation and a leading risk factor for both perioperative mortality and chronic rejection. Unfortunately, ACR has a vague clinical presentation that can mimic other post-transplant pathology, typically requiring an invasive biopsy for diagnosis. The mainstay of therapy is escalation of immunosuppression, which presents a dilemma for patients that are already prone to infection. Novel therapies are greatly needed but have been hindered by our limited understanding of this complex, multifaceted disease process. Research over the last few decades has revealed that the immune pathways governing ACR can occur within the lung graft. Future therapies aimed at suppressing inflammatory pathways and augmenting anti-inflammatory pathways locally within the graft may hold the key to improving patient outcomes. In this article, we discuss the underlying mechanisms, clinical manifestations, and management strategies of ACR.