Post-lung transplant surveillance in 2026: current practice, variability, and the need for standardization

Area of Science:

• Medicine
• Transplantation
• Pulmonology

Background:

• Post-lung transplant surveillance lacks a universally accepted standard, resulting in heterogeneous care practices.
• Current surveillance methods include physiological testing, imaging, bronchoscopy, laboratory monitoring, and biomarkers, but face limitations and variability.
• This heterogeneity hinders the timely detection of allograft dysfunction and impacts patient outcomes.

Purpose of the Study:

• To synthesize current post-lung transplant surveillance practices across various domains.
• To identify key limitations, sources of variability, and evidence gaps in existing surveillance strategies.
• To highlight areas where established and novel tools support routine use versus investigational application.

Main Methods:

• This study is a narrative review of current post-lung transplant surveillance practices.
• It synthesizes information on organization of care, lung function monitoring, radiological assessment, invasive diagnostics, and laboratory parameters.
• Emerging biomarkers and their evidence base are also summarized.

Main Results:

• Surveillance practices are fragmented, with inconsistent data interpretation and limited integration of novel diagnostics.
• These issues contribute to delayed recognition of graft injury and variable patient outcomes.
• Evidence supporting routine use of certain tools is limited, while others remain investigational.

Conclusions:

• Advancing post-transplant care necessitates consensus-driven minimum surveillance standards.
• Developing trajectory-based interpretation frameworks is essential for consistent data analysis.
• Rational incorporation of validated biomarkers and digital technologies into harmonized follow-up pathways is required.