A spirometric journey following lung transplantation

Area of Science:

• Pulmonology
• Transplant Surgery
• Immunology

Background:

• Spirometry is the gold standard for assessing lung function in lung transplant (LTx) recipients.
• Chronic lung allograft dysfunction (CLAD) encompasses various phenotypes, including bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), each with distinct characteristics and treatment approaches.

Observation:

• A 60-year-old male recipient, post-LTx for idiopathic pulmonary fibrosis, initially showed improved lung function.
• Lung function declined, leading to a BOS diagnosis, necessitating a second LTx.
• Post-second LTx, lung function improved but later deteriorated, diagnosed as RAS, with antibody-mediated rejection suspected.

Findings:

• Spirometry demonstrated distinct functional patterns corresponding to BOS and RAS.
• The case highlights the dynamic nature of CLAD phenotypes following lung transplantation.
• Sequential LTx and evolving CLAD underscore the need for precise diagnostic tools.

Implications:

• This case underscores the critical role of serial spirometry in identifying and differentiating CLAD phenotypes.
• Accurate spirometric assessment is essential for timely therapeutic interventions in lung transplant recipients.
• Understanding CLAD patterns aids in managing graft dysfunction and optimizing long-term transplant outcomes.