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

Post-lung transplant surveillance remains highly heterogeneous, with no universally accepted standard guiding organisation of care or the use of physiological testing, imaging, bronchoscopy, laboratory monitoring, and emerging biomarkers. This narrative review synthesises current surveillance practices across these domains and addresses key limitations, sources of inter-centre variability, and evidence gaps that hinder timely detection of allograft dysfunction. We summarize established and evolving approaches to organisation of care, lung function monitoring, radiological assessment, invasive diagnostics, and laboratory parameters, along with novel biomarkers, highlighting where evidence supports routine use and where tools remain investigational. Fragmentation of follow-up strategies, inconsistent interpretation of longitudinal data, and limited integration of novel diagnostics contribute to delayed recognition of graft injury and variable outcomes. Advancing post-transplant care will require consensus-driven definition of minimum surveillance standards, trajectory-based interpretation frameworks, and rational incorporation of validated biomarkers and digital technologies into harmonised follow-up pathways.