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Area of Science:

  • Transplant Immunology
  • Pulmonary Medicine
  • Allograft Pathology

Background:

  • Acute cellular rejection (ACR) affects nearly 30% of lung transplant recipients within the first year.
  • While often responsive to initial treatment, ACR is linked to adverse long-term outcomes like chronic lung allograft dysfunction.
  • Refractory or recurrent ACR significantly worsens lung function and increases healthcare burden.

Purpose of the Study:

  • To review current evidence on the epidemiology, pathogenesis, and risk factors of ACR post-lung transplantation.
  • To describe current diagnostic and therapeutic strategies and emerging diagnostic tools for ACR.
  • To examine the association of ACR with other adverse lung transplant outcomes and identify areas of controversy and future research.

Main Methods:

  • Comprehensive literature review of ACR in lung transplantation.
  • Synthesis of evidence on ACR epidemiology, pathogenesis, risk factors, diagnosis, and treatment.
  • Analysis of ACR's impact on long-term lung allograft survival and function.

Main Results:

  • ACR is a frequent complication with significant long-term consequences, despite initial treatment success.
  • Knowledge gaps persist regarding ACR risk factors, optimal monitoring, and outcome prediction.
  • Variability in clinical practice complicates multicenter research on ACR.

Conclusions:

  • Understanding ACR mechanisms and optimizing management are crucial for improving lung transplant outcomes.
  • Further research is needed to address uncertainties in ACR risk stratification, monitoring, and prediction.
  • Standardizing practices and developing novel diagnostic tools are essential for advancing lung transplant care.