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Semin Respir Crit Care Med 2021; 42(03): 411-427
DOI: 10.1055/s-0041-1729542
Review Article

Acute Rejection in the Modern Lung Transplant Era

Benjamin Renaud-Picard‡   *
1   Division of Respirology and Toronto Lung Transplant Program, University of Toronto and University Health Network, Toronto, Canada
,
Angela Koutsokera‡   *
2   Division of Pulmonology, Lung Transplant Program, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
,
Michael Cabanero
3   Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
,
Tereza Martinu
1   Division of Respirology and Toronto Lung Transplant Program, University of Toronto and University Health Network, Toronto, Canada
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Abstract

Acute cellular rejection (ACR) remains a common complication after lung transplantation. Mortality directly related to ACR is low and most patients respond to first-line immunosuppressive treatment. However, a subset of patients may develop refractory or recurrent ACR leading to an accelerated lung function decline and ultimately chronic lung allograft dysfunction. Infectious complications associated with the intensification of immunosuppression can also negatively impact long-term survival. In this review, we summarize the most recent evidence on the mechanisms, risk factors, diagnosis, treatment, and prognosis of ACR. We specifically focus on novel, promising biomarkers which are under investigation for their potential to improve the diagnostic performance of transbronchial biopsies. Finally, for each topic, we highlight current gaps in knowledge and areas for future research.

Keywords

lung transplantation - acute rejection - cellular rejection - transplant immunology

* These authors contributed equally.




Publication History

Article published online:
24 May 2021

© 2021. Thieme. All rights reserved.

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