Pathology of the Lung Allograft

Recent advances in immunosuppressive medications, clinical immunology, patient selection, and surgical techniques have improved the outcome of lung transplants as a group, yet the overall survival is still the lowest among all solid organ allografts. Pathology has played a primordial role in this process by the recognition and understanding of the multifactorial complications that may affect lung allografts and decrease both organ and patient survival. In this chapter, we present the latest understanding and classification of the most common complication of lung allografts, including primary allograft dysfunction, acute cellular vs. antibody-mediated rejection, obstructive vs. restrictive chronic allograft injury, chronic allograft vasculopathy, infections of the transplanted lung, and special topics that include recurrent diseases in the lung transplant and posttransplant lymphoproliferative disorders. Classifications followed the International Society of Heart and Lung Transplant guidelines for both cellular and antibody-mediated rejection. We also refer to selected articles published in the medical literature and mention, when appropriate, our own experience in dealing with lung allograft biopsies and resection specimens.