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Immune processes in the pathogenesis of chronic lung allograft dysfunction: identifying the missing pieces of the puzzle

Lookup NU author(s): Saskia BosORCiD, Dr Luke Milross, Professor Andrew FilbyORCiD, Professor Andrew FisherORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© The authors 2022.Lung transplantation is the optimal treatment for selected patients with end-stage chronic lung diseases. However, chronic lung allograft dysfunction remains the leading obstacle to improved long-term outcomes. Traditionally, lung allograft rejection has been considered primarily as a manifestation of cellular immune responses. However, in reality, an array of complex, interacting and multifactorial mechanisms contribute to its emergence. Alloimmune-dependent mechanisms, including T-cell-mediated rejection and antibody-mediated rejection, as well as non-alloimmune injuries, have been implicated. Moreover, a role has emerged for autoimmune responses to lung self-antigens in the development of chronic graft injury. The aim of this review is to summarise the immune processes involved in the pathogenesis of chronic lung allograft dysfunction, with advanced insights into the role of innate immune pathways and crosstalk between innate and adaptive immunity, and to identify gaps in current knowledge.

Publication metadata

Author(s): Bos S, Milross L, Filby AJ, Vos R, Fisher AJ

Publication type: Review

Publication status: Published

Journal: European Respiratory Review

Year: 2022

Volume: 31

Issue: 165

Online publication date: 27/07/2022

Acceptance date: 19/05/2022

ISSN (print): 0905-9180

ISSN (electronic): 1600-0617

Publisher: European Respiratory Society


DOI: 10.1183/16000617.0060-2022