Acute lung rejection: An important factor for long term survival in lung transplantation

Pulmonary transplantation has been used as treatment of choice in patients with advanced disease. Since the introduction of immunosuppressive and new advancement in postoperative management, the survival rate of lung transplantation has improved. However in the long run, survival rate decreases years after lung transplantation. According to ISHLTH 32^nd report, survival rate decreased to 54% after 5 years, and decreased to 31% after 10 years. Leading cause of mortality was found to be graft failure, which may be caused by acute rejection or chronic rejection. Based on the mechanism of action, acute rejection can be classified into acute cellular rejection (ACR), and antibody mediated rejection (AMR). Due to unspecific signs and symptoms in acute rejection, diagnostic procedures must be conducted to help diagnosis. Various modalities are available, but lung biopsy is still considered as the gold standard. Treatment for acute rejection varies in different centers. There are no published guidelines discussing treatment for lung rejection due to lack of published evidence. Further studies evaluating the pathogenesis, diagnosis modalities, and treatment of choice for acute rejection are needed to improve patients’ survival rate.