Background Transfusion-related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion-related mortality. Objective Through the analysis of researches in recent years, to review the possible pathogenesis of TRALI . Content In recent years people has made a lot of exploration about the pathogenesis of TRALI, but the exact mechanism remains unclear. The mechanism may be many ways and many factors involved in, the more accepted mechanism is "antigens-antibodies" theory, "two hit" theory and threshold theory. Trend Through the correct understanding and exploring the pathogenesis of TRALI to provide new ideas for the clinical and research in the future.