Introduction: Acute cellular rejection (ACR) constitutes a T cell-mediated inflammatory response primarily targeting the allograft airways and blood vessels. ACR stands as a significant risk factor for chronic lung allograft dysfunction (CLAD), which remains a leading cause of mortality in lung transplant recipients. Diagnosis of ACR relies on the identification of characteristic histopathological features observed in transbronchial biopsy specimens. While ACR may present with nonspecific inflammatory symptoms such as low-grade fever and cough, patients often remain asymptomatic. Despite the profound impact of ACR on lung allograft outcomes, there remains a lack of consensus regarding the utility of surveillance bronchoscopy for timely diagnosis in asymptomatic patients. 
Methods: We conducted a retrospective review of 250 lung transplant recipients who underwent the procedure at our institution between 2016 and 2022. Our analysis included examining the frequency of surveillance bronchoscopies and clinically indicated procedures, as well as assessing the histopathologic staging of ACR and the corresponding treatments administered.
Results: Among the 250 patients reviewed, 17 (6.8%) were diagnosed with ACR. 2 patients were diagnosed on clinically warranted bronchoscopy while the remaining 15 were all diagnosed on surveillance bronchoscopy. The cellular rejection grade was A1 for 9 patients and A2 for 8 patients. All patients were treated with oral steroids. Out of the total cohort, 78 patients did not undergo any bronchoscopies while among those who underwent bronchoscopies, the average number of procedures were 2 per patient. 
Conclusion: Early detection and treatment of ACR are crucial in preventing further complications such as the development of CLAD. Our findings highlight the significance of surveillance bronchoscopy in detecting ACR, particularly as the majority of our patients were asymptomatic and would not have been diagnosed using a clinically warranted approach alone.