I am a Professor of Medicine in the Division of Pulmonary, Critical Care and Allergy at Stanford University specializing in the evaluation and management of lung transplant (LT) recipients. As a UNOS-certified LT physician, my clinical focus has been dedicated to optimizing patient outcomes after LT. Before joining Stanford, I held an endowed Chair in Lung Transplantation and served as the Medical Director of LT and the Director of Pulmonary Vascular Disease at the University of Texas Health Science Center in San Antonio. My research focuses translational and clinical efforts to improve LT outcomes, particularly in relation to Antibody-Mediated Rejection (AMR) and Chronic Lung Allograft Dysfunction (CLAD) after transplant. Since 2007, I have worked on elucidating the association between donor specific antibodies (DSA), AMR and CLAD, including risk stratification of both entities. In 2016, I led the International Society of Heart and Lung Transplantation (ISHLT) AMR Working Group in establishing criteria and publishing the international guidelines on AMR, which are now utilized clinically worldwide. Currently, in 2025, I am co-leading the second iteration of these guidelines. Our focus is to attempt to fill the critical gaps that remain in our understanding of AMR’s pathogenesis, morphologic feathers and clinical presentation. One key challenge is the heterogeneity of DSA-related graft injury—as its rate, pattern, and progression vary significantly, limiting its utility as a reliable prognostic marker. My long-term goal is to refine AMR diagnostic criteria into a composite prognostic system, enabling risk stratification and individualized patient assessment. Enhancing the predictive value of DSA and other AMR and CLAD biomarkers is one of the most pressing unmet needs in CLAD prevention and management.
