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Management of Posttransplant Lung Disease

Over 60,000 individuals undergo solid organ or hematopoietic cell transplantation in the United States each year. Because the lungs are both exposed to the contaminated environment of ambient air and a relative hotbed of immunologic activity even in health, pulmonary complications are common and important in this clinical context. Lung transplantation and allogeneic bone marrow transplantation are the focus of this paper since pulmonary complications are most common and most devastating in these situations. Both infectious and noninfectious inflammatory complications are examined from both diagnostic and therapeutic points of view. Acute and chronic graft rejection remains a significant barrier to long-term survival after lung transplantation. Pulmonary complications after bone marrow transplantation are highly time dependent and continue to cause significant morbidity. The similarities and differences between bronchiolitis obliterans associated with chronic graft versus host disease and lung transplantation are briefly outlined. We also emphasize recent developments that hopefully will lead to improved outcomes in the 21st century.