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The Proceedings of the American Thoracic Society 6:108-121 (2009)
© 2009 The American Thoracic Society
doi: 10.1513/pats.200807-073GO
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Chronic Lung Allograft Rejection

Mechanisms and Therapy

John A. Belperio1, S. Samuel Weigt1, Michael C. Fishbein2 and Joseph P. Lynch, III1

1 Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, and 2 Department of Pathology and Laboratory Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

Correspondence and requests for reprints should be addressed to John A. Belperio III, M.D., The David Geffen School of Medicine at UCLA, Division of Pulmonary, Critical Care Medicine, and Hospitalists, 10833 Le Conte Ave, 37-131 CHS, Los Angeles, CA 90095. E-mail: jbelperio{at}mednet.ucla.edu

ABSTRACT

Lung transplantation is a therapeutic option for patients with end-stage pulmonary disorders. Unfortunately, due to post–lung transplant complications, both infectious and noninfectious, it is only a treatment and not a cure. Importantly, despite induction combined with triple or quadruple maintenance immunosuppressive therapy, chronic lung rejection, in the form of obliterative bronchiolitis or its clinical correlate bronchiolitis obliterans syndrome (BOS), continues to be highly prevalent and is the major limitation to long-term survival. In this review we evaluate the presentation, diagnosis, histopathology, pathologic mechanisms, risk factors, and prevention/treatment options for BOS. A better understanding of the risk factors and how it relates to the pathologic mechanisms of chronic lung allograft rejection should lead to better pharmacologic targets to prevent/treat this syndrome without increasing the recipient's risk for infections.

Key Words: lung transplant • chronic allograft rejection • acute allograft rejection • obliterative bronchiolitis • bronchiolitis obliterans syndrome






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