Acute Rejection and Chronic Lung Allograft Dysfunction: Obstructive and Restrictive Allograft Dysfunction

Area of Science:

• Immunology
• Transplantation Medicine
• Pulmonology

Background:

• Lung transplantation is a vital treatment for end-stage respiratory diseases.
• Lung transplant recipients experience the highest rates of acute and chronic rejection.
• Allograft decline is common due to alloimmune responses and post-transplant injuries.

Purpose of the Study:

• To review current knowledge on acute cellular rejection (ACR) and chronic lung allograft dysfunction (CLAD).
• To identify barriers and knowledge gaps in managing ACR and CLAD.
• To address the primary impediments to long-term survival in lung transplant recipients.

Main Methods:

• Literature review of current research on lung transplant rejection.
• Analysis of factors contributing to alloimmune recognition and allograft remodeling.
• Synthesis of information on pathophysiological decline in lung allografts.

Main Results:

• ACR and CLAD remain significant challenges in lung transplantation.
• Multifactorial injuries precipitate immune-driven remodeling of the bronchovascular axis.
• Most recipients experience functional and/or structural allograft decline.

Conclusions:

• Understanding and overcoming ACR and CLAD are critical for improving long-term lung transplant outcomes.
• Addressing knowledge gaps in rejection mechanisms is essential.
• Reducing the impact of alloimmune recognition and injury is key to enhancing post-transplant survival.