Rationale:The role of transbronchial lung biopsy after lung transplantation has been questioned. Supporters favor the diagnostic precision afforded by repeated histopathological examination of the allograft and point to a satisfactory risk‐benefit ratio in experienced hands. The contrary viewpoint emphasizes a lack of cost efficiency for surveillance biopsies versus clinically mandated studies. This review therefore examines the evidence supporting each case and provides a background to allow an understanding of the history of this invasive diagnostic test. The special role of follow‐up biopsies to assess the impact of targeted therapies and to chronicle the natural history of untreated “minor” rejection events is then examined critically.Recent findings:The proposed simple nexus between biopsy‐proven acute pulmonary allograft rejection and the development of obliterative bronchiolitis is now understood to be more complex. Recent studies of large numbers of recipients followed with surveillance and clinically mandated transbronchial biopsies for sufficient time periods to develop a robust assessment of outcomes now support the concept that allograft rejection should be viewed as a continuum rather than a discrete series of high grade events and hence that it is the time‐weighted sum of rejection that is important. A similar concept for infective events also has support.Summary:While the individual risk‐benefit ratio must dictate the performance (or not) of transbronchial biopsy in a particular patient, the accumulating data now support early surveillance procedures with follow‐up studies to assess resolution of events and to detect adverse outcomes of therapies.