Lung allograft rejection: Diagnosis and management

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.