Autoimmunity and lung transplantation

Lung transplantation is a viable treatment option for a variety of end-stage lung diseases. Since the first successful human lung transplant about 20 years ago, tremendous progress has been made in this field. However, lung allografts have the poorest long term survival compared to other solid organs. The predominant reason for this is the development of chronic rejection, also known as bronchiolitis obliterans syndrome (BOS). Although the traditional view supports alloimmunity as the major cause of chronic rejection, emerging evidence reveals a complex interplay of multiple etiologies including peri-operative stressors, inflammation, and autoimmunity along with alloimmunity. Identification of autoimmunity in the pathogenesis of BOS is an exciting recent finding in lung transplantation and promises to introduce novel strategies for future therapeutic interventions. In this review, we discuss recent studies and concepts related to the role of autoimmunity in the development of BOS.