Acute cellular rejection (ACR) remains a common complication after lung transplantation. Mortality directly related to ACR is low and most patients respond to first-line immunosuppressive treatment. However, a subset of patients may develop refractory or recurrent ACR leading to an accelerated lung function decline and ultimately chronic lung allograft dysfunction. Infectious complications associated with the intensification of immunosuppression can also negatively impact long-term survival. In this review, we summarize the most recent evidence on the mechanisms, risk factors, diagnosis, treatment, and prognosis of ACR. We specifically focus on novel, promising biomarkers which are under investigation for their potential to improve the diagnostic performance of transbronchial biopsies. Finally, for each topic, we highlight current gaps in knowledge and areas for future research.

急性细胞排斥反应 (ACR) 仍然是肺移植后的常见并发症。与 ACR 直接相关的死亡率很低，大多数患者对一线免疫抑制治疗有反应。然而，一部分患者可能会出现难治性或复发性 ACR，导致肺功能加速下降并最终导致慢性同种异体肺功能障碍。与免疫抑制强化相关的感染性并发症也会对长期生存产生负面影响。在这篇综述中，我们总结了关于 ACR 的机制、危险因素、诊断、治疗和预后的最新证据。我们特别关注新的、有前途的生物标志物，这些生物标志物正在研究中，以提高经支气管活检的诊断性能。最后，对于每个主题，