Targeting Allograft Injury and Inflammation in the Management of Post‐Lung Transplant Bronchiolitis Obliterans Syndrome

Chronic allograft dysfunction, manifesting as bronchiolitis obliterans syndrome (BOS), is the major cause of morbidity and mortality in human lung transplant recipients. While alloimmunity has a definite role, there is increasing interest in overall allograft injury and subsequent inflammation and remodeling. This review deals with nonalloimmune factors that may potentiate alloimmune injury. We discuss infection and reflux/aspiration as examples of allograft injury, which may lead to chronic loss of graft function and BOS. Surgical and nonsurgical treatments aimed at preventing these insults and improving survival are considered. The need for further evidence, including randomized‐controlled trials, to evaluate the role of medical and surgical therapies is emphasized by the current literature. Non‐alloimmune lung allograft injuries such as ischemia, infection, and reflux are potentially important targets for strategies to improve lung transplant outcomes.