Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine, such that there is a significant lack of data regarding the efficacy for these in pulmonary AMR. Lastly, outcomes after AMR remain quite poor despite aggressive treatment. In this review, we revisit the history of AMR in lung transplantation, describe our current understanding of its pathophysiology, discuss the use and limitations of the consensus diagnostic criteria, review current treatment strategies, and summarize long-term outcomes. We conclude with a synopsis of our most pressing gaps in knowledge, introduce recommendations for future directions, and highlight promising areas of active research.

抗体介导的排斥反应 (AMR) 现在是一种广泛认可的肺移植排斥反应形式，越来越多的证据表明 AMR 是发展为慢性同种异体移植肺功能障碍和显着降低长期存活率的重要风险因素。尽管最近制定了共识诊断标准，但它仍然是一个具有挑战性的排除诊断。此外，即使在诊断后，针对肺 AMR 的治疗也几乎完全来自其他实体器官移植和其他医学领域的实践，因此严重缺乏关于这些在肺 AMR 中的疗效的数据。最后，尽管积极治疗，AMR 后的结果仍然很差。在这篇综述中，我们回顾了 AMR 在肺移植中的历史，描述了我们目前对其病理生理学的理解，讨论共识诊断标准的使用和局限性，审查当前的治疗策略，并总结长期结果。最后，我们概述了我们在知识方面最紧迫的差距，介绍了对未来方向的建议，并强调了积极研究的有希望的领域。