Lung transplantation in 2025: a narrative review of progress, challenges, and the road ahead

Lung transplantation (LTx) remains the only definitive treatment for end-stage lung disease. Throughout 2025, the global transplant community has made notable progress in addressing persistent challenges in the field, ranging from policy-level improvements in graft allocation to deeper biological insights into post-transplant complications. This review aims to synthesize the pivotal literature published in 2025 across four core areas: optimizing allocation, advancing perioperative care, defining the mechanisms of graft injury, and exploring translational frontiers.

We conducted a structured literature search focused primarily on studies published in 2025 that highlight major advancements in LTx. In addition, the search was supplemented with key society guidelines, consensus statements, and relevant early 2026 publications. Selected articles were critically analyzed and categorized into clinical advancements, and basic/translational findings.

In clinical research, the refinement of allocation strategies and the expansion of donor criteria, have effectively broadened access. Perioperative management has evolved with the integration of artificial intelligence to predict complications such as primary graft dysfunction (PGD) and chronic lung allograft dysfunction (CLAD). In basic and translational research, studies have dissected the molecular basis of complications. Additionally, new insights into the evolution of drug-resistant pathogens and macrophage plasticity have deepened our understanding of infection and rejection.

In 2025, significant progress has been achieved in the field of LTx research. Strategies for clinical donor allocation and perioperative management, along with the understanding of molecular mechanisms underlying complications, have also been greatly improved. These advancements are essential to further optimize outcomes and address the complex challenges in LTx.