Introduction

The Registry of the International Society for Heart and Lung Transplantation (ISHLT) has reported survival rates of 64% and18% at 1 and 14 years, respectively, for heart–lung transplantation and of 70%, 45% and 20% at 1, 5 and 10 years, respectively, for lung transplantation [1]. Despite the increasing range and sophistication of immunosuppressive and antimicrobial drugs, the main causes of morbidity and mortality occurring after the immediate postoperative period remain acute rejection, infection and, in late survivors, obliterative bronchiolitis. In order to improve the results of lung transplantation, early diagnosis and treatment of post operative complications are essential. The his to pathologist has a role to play in this process in terms of biopsy diagnosis of, and research into, the pulmonary and systemic complications (Table 23.1) and in contributing to clinical audit through postmortem examination [2]. In addition, review of lung biopsies taken prior to transplantation may confirm the referral diagnosis, which, in turn, is audited by histological examination of the explanted lung. In a small number of cases this may reveal a different, or an additional diagnosis, sometimes in the context of systemic disease, with implications for post-transplantation management [3] (see Chapter 10).

Technical aspects of lung allograft pathology

The his to pathologist must ensure that the clinical requirement for a rapid biopsy reporting service, including an on-call service, can be met. In addition to standard technology, he/she should have access to a variety of specialist techniques including immunohistochemistry (IHC) and molecular techniques such as in situ hybridization (ISH) and the polymerase chain reaction (PCR). Review of biopsies at regular joint clinical pathology meetings is important in patient management.