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Development of Obliterative Bronchiolitis in a Murine Model of Orthotopic Lung Transplantation

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

Hanne Beeckmans¹, Saskia Bos², Robin Vos³

¹Department of Chronic Diseases and Metabolism, KU Leuven, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium.

Clinics in Chest Medicine

|February 11, 2023

Summary

Lung transplant recipients face high rejection rates. This review covers acute cellular rejection and chronic lung allograft dysfunction, key challenges to long-term survival after lung transplantation.

Keywords:

Acute cellular rejection Bronchiolitis obliterans syndrome Chronic lung allograft dysfunction Lung transplantation Restrictive allograft syndrome T-cell-mediated rejection

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Published on: August 15, 2022

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.