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Review
. 2020 Mar;8(6):417.
doi: 10.21037/atm.2020.01.05.

An update on chronic lung allograft dysfunction

Sakhee Kotecha  1 , Miranda A Paraskeva  1 , Kovi Levin  1 , Gregory I Snell  1
Affiliations
Review

An update on chronic lung allograft dysfunction

Sakhee Kotecha et al. Ann Transl Med. 2020 Mar.

Abstract

Chronic lung allograft dysfunction (CLAD) remains a significant challenge and the major determinant of morbidity and mortality post lung transplantation (LTx). The definition of CLAD has evolved significantly over the last ten years, reflecting better understanding of pathophysiology and different phenotypes. While there is an agreed consensus approach to CLAD, questions remain regarding the limitations of lung function parameters as well as the role of imaging and histopathology. Here we present a current snapshot of the definition of CLAD, its evolution and future directions.

Keywords: Lung transplantation (LTx); chronic lung allograft dysfunction (CLAD).

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Conflict of interest statement

Conflicts of Interest: The series “Strategies to Achieve Long-Term Success of Lung Transplantation” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
The state of lung allograft dysfunction circa 2016. BOS, bronchiolitis obliterans syndrome; RAS, restrictive allograft syndrome; ARAD, azithromycin-reversible allograft dysfunction.
Figure 2
Figure 2
The position of lung allograft AMR in lung allograft dysfunction circa 2016. BOS, bronchiolitis obliterans syndrome; RAS, restrictive allograft syndrome; AMR, antibody mediated rejection; CLAD, chronic lung allograft dysfunction; ARAD, azithromycin-reversible allograft dysfunction.
Figure 3
Figure 3
The current state of lung allograft dysfunction. BLAD, baseline allograft dysfunction; CLAD, chronic lung allograft dysfunction; FEV1, forced expiratory volume in 1 second; BOS, bronchiolitis obliterans syndrome; RAS, restrictive allograft syndrome; AMR, antibody mediated rejection; FOP, fibrinoid organising pneumonia; DAD, diffuse alveolar damage; NSIP, non-specific interstitial pneumonia; PPFE, pleuro-parenchymal fibro-elastosis; ALAD, acute lung allograft dysfunction. ARAD, azithromycin-reversible allograft dysfunction.
Figure 4
Figure 4
Upper zone predominant fibrosis and reticulation seen in RAS (A) compared to the mosaic perfusion and bronchial wall thickening appearance in BOS (B). RAS, restrictive allograft syndrome; BOS, bronchiolitis obliterans syndrome.
See this image and copyright information in PMC

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