Pirfenidone has a simple chemical structure, but may have profound implications for transplantation management. One of the leading causes of allograft failure is chronic allograft dysfunction, manifested by chronic inflammation and chronic fibrosis [Estenne, M., Hertz, M.I., 2002. Bronchiolitis obliterans after human lung transplantation. AJRCCM. 166, 440–444.]. This review summarizes the literature to date on Pirfenidone in the setting of transplantation, and those studies pertinent to the mechanisms of organ rejection and possible use of Pirfenidone in transplantation patients.