Current views on chronic rejection after lung transplantation

Area of Science:

• Pulmonology
• Transplantation Medicine
• Immunology

Background:

• Chronic lung allograft dysfunction (CLAD) is a major complication after lung transplantation.
• CLAD was initially defined by bronchiolitis obliterans syndrome (BOS), an obstructive pattern.
• Restrictive allograft syndrome (RAS) emerged as a distinct phenotype with restrictive FEV1 decline.

Purpose of the Study:

• To review the two main phenotypes of CLAD: BOS and RAS.
• To discuss diagnostic criteria, pathology, and imaging for CLAD.
• To explore risk factors, outcomes, and treatment strategies for CLAD.

Main Methods:

• Literature review of CLAD phenotypes, diagnostic criteria, pathology, imaging, risk factors, and treatment.
• Synthesis of current understanding of BOS and RAS in lung transplantation.

Main Results:

• CLAD is characterized by BOS (obstructive) and RAS (restrictive) patterns of pulmonary function decline.
• Accurate diagnosis requires careful evaluation of pulmonary function tests, pathology, and imaging.
• Risk factors, prognosis, and treatment options differ between BOS and RAS.

Conclusions:

• CLAD is a complex syndrome with distinct phenotypes requiring tailored management.
• Further research is needed to optimize treatment and improve outcomes for lung transplant recipients with CLAD.