Surgical therapy of chronic lung allograft dysfunction

Area of Science:

• Pulmonology and Transplant Medicine
• Immunology
• Surgical Innovation

Background:

• Lung transplantation is a vital treatment for end-stage lung disease.
• Chronic lung allograft dysfunction (CLAD) is a primary threat to long-term graft survival.
• Understanding CLAD's pathology and clinical features is crucial for patient management.

Approach:

• This review synthesizes current knowledge on CLAD histopathology and clinical manifestations.
• It examines lung re-transplantation, including its complications and outcomes for urgent cases supported by extracorporeal membrane oxygenation.
• The review also discusses fundoplication as a supportive surgical intervention and outlines non-surgical treatments and ongoing research.

Key Points:

• CLAD presents distinct histopathological and clinical characteristics.
• Lung re-transplantation offers a causal therapy for CLAD, with outcomes varying by urgency.
• Extracorporeal membrane oxygenation (ECMO) may support high-urgency patients awaiting re-transplantation.
• Fundoplication is a relevant surgical option for improving patient condition.
• Nonsurgical treatments and innovative research aim to prolong allograft life.

Conclusions:

• Effective management of CLAD requires a multifaceted approach, integrating surgical and non-surgical strategies.
• Further research is essential to improve long-term outcomes for lung transplant recipients facing CLAD.
• Optimizing patient care involves addressing CLAD's complexities through established and novel therapeutic avenues.