The first successful human lung transplant was performed in 1983 by the Toronto Lung Transplant Group. 1 More than two decades have passed since this landmark procedure, and in the interim over 17,000 lung transplants have been performed.2 Lung transplantation currently is the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has occurred through refinement in technique and improved understanding of transplant immunology and microbiology. The 1-, 3-, 5-, and 10-year actuarial survival rates for all lung transplants are 74%, 58%, 47%, and 24%, respectively.2 Despite these improvements, donor shortages and chronic lung allograft rejection continue to plague the field and prevent it from reaching its full potential. Chronic rejection of the lung allograft is currently the major hurdle limiting long-term survival. To date, prevention of known risk factors and treatment strategies have not lessened the devastating toll this process has on lung transplant survival.