[Lung transplantation and rejection. Basic principles, clinical aspects and histomorphology]

Area of Science:

• Pulmonology
• Transplant Surgery
• Immunology

Context:

• Lung transplantation is a critical treatment for end-stage lung disease in adults and children.
• Long-term survival post-transplant has seen limited improvement compared to first-year outcomes.
• Acute cellular rejection is a primary factor in pulmonary graft dysfunction and chronic rejection, such as bronchiolitis obliterans syndrome (BOS).

Purpose:

• To highlight the persistent challenges in long-term lung transplant survival.
• To identify acute cellular rejection as a key impediment to graft function and longevity.
• To acknowledge the evolution of diagnostic criteria, referencing the 2006 ISHLT grading system revision.

Summary:

• Despite advances, long-term survival after lung transplantation has not significantly improved.
• Acute cellular rejection significantly impairs pulmonary graft function and contributes to chronic rejection (BOS).
• The International Society for Heart and Lung Transplantation (ISHLT) updated its grading system for rejection in 2006.

Impact:

• Underscores the need for improved strategies to manage acute and chronic rejection.
• Emphasizes the importance of understanding rejection mechanisms for enhancing long-term transplant success.
• Provides context for ongoing research into mitigating graft dysfunction and improving patient outcomes.