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Acute Fibrinoid Organizing Pneumonia in Lung Transplant: The Most Feared Allograft Dysfunction.

L transplantation is the standard of care for selected patients with advanced lung diseases, and the median time after procedure is markedly increasing; therefore the prevalence of chronic lung allograft dysfunction (CLAD) tends to increase in this population. Acute fibrinoid organizing pneumonia (AFOP) after lung transplantation has been described by Paraskeva et al in lung transplant patients who have neither of the 2 unique forms of lung allograft dysfunction, termed bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). They propose that AFOP should be considered as a novel form of CLAD associated with very poor prognosis with median time to death of 101 days after AFOP diagnosis. These data are important because they suggest that there may be a new form of CLAD that has worse outcomes compared with the other forms. We hypothesized that AFOP may be present in lung transplant recipients, but the prognosis is uncertain in these patients. In this context, we retrospectively evaluated histopathological data of 232 patients who underwent lung transplantation between January 2000 and July 2010 to study the presence of