Abstract
Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft
rejection, with mounting evidence for AMR as an important risk factor for the development
of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite
the recent development of the consensus diagnostic criteria, it remains a challenging
diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary
AMR has been nearly exclusively derived from practices with other solid-organ transplants
and other areas of medicine, such that there is a significant lack of data regarding
the efficacy for these in pulmonary AMR. Lastly, outcomes after AMR remain quite poor
despite aggressive treatment. In this review, we revisit the history of AMR in lung
transplantation, describe our current understanding of its pathophysiology, discuss
the use and limitations of the consensus diagnostic criteria, review current treatment
strategies, and summarize long-term outcomes. We conclude with a synopsis of our most
pressing gaps in knowledge, introduce recommendations for future directions, and highlight
promising areas of active research.
Keywords
lung transplantation - graft rejection - acute lung injury - complement C4d - donor-specific
antibodies - diagnostic techniques and procedures - outcome assessment
