Pathology of the Lung Transplant

Pathology is a cornerstone in the care of all solid organ transplant patients, but it is nowhere of more importance than in the setting of lung transplantation. The lung is unique among transplanted organs in its extensive exposure to the external environment, subjecting it to a number of infectious and physical injuries not shared by other transplants; many of these complications are best diagnosed by pathologic examination of biopsy specimens. Furthermore, flexible bronchoscopy provides a safe and convenient way to directly examine the allograft and allow for frequent and prospective pathological examination of the transplanted organ. Many forms of lung transplant pathology are at first clinically inapparent or present with nonspecific symptoms; histopathologic examination of lung transplant biopsy material thus serves a key role in the surveillance and diagnosis of lung allograft complications. Finally, since lung transplantation is a relatively young field, pathologic examination is crucial to our evolving understanding of the biology of the pulmonary allograft. It was not until the mid-1980s that Cooper and colleagues achieved the first successful long-term outcomes in a series of patients with idiopathic pulmonary fibrosis undergoing single lung transplant (1). Thus, in a relatively short time lung transplantation has evolved into an acceptable and effective therapy for many advanced lung diseases including emphysema, cystic fibrosis, and idiopathic pulmonary fibrosis, as well as more rare conditions. In this chapter, we review the broad spectrum of pathological conditions that arise in human lung transplants as well as methods for procurement and processing of samples for diagnostic analysis. Obtaining Tissue for Pathologic Examination.

Duke Scholars

Author David Noble Howell Pathology

Author Scott Michael Palmer Jr. Medicine, Pulmonary, Allergy, and Critical Care Medicine