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Related Experiment Video

Updated: Feb 26, 2026

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease

Published on: June 16, 2020

Clinical features associated with chronic lung allograft dysfunction progression in a multicenter cohort.

Jamie L Todd^1,2, Megan L Neely^2,3, Jesse Y Hsu⁴

¹Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, United States.

American Journal of Respiratory and Critical Care Medicine

|February 25, 2026

Summary

Objective clinical measures at chronic lung allograft dysfunction (CLAD) diagnosis predict graft loss in lung transplant recipients. Higher CLAD stage, early onset, and FVC loss increase graft loss risk, aiding prognostication.

Keywords:

chronic lung allograft dysfunction chronic lung allograft dysfunction progression graft loss lung transplant

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Area of Science:

Pulmonary Medicine
Transplantation Immunology
Clinical Outcomes Research

Background:

Chronic lung allograft dysfunction (CLAD) is a major cause of lung transplant failure.
Current phenotyping methods for CLAD are inconsistent and lack standardization.
Predicting outcomes in lung transplant recipients with CLAD requires objective measures.

Purpose of the Study:

To determine if routine clinical measures at CLAD diagnosis predict graft loss.
To analyze the impact of CLAD stage, timing, and lung function decline on transplant outcomes.
To identify objective markers for stratifying CLAD progression risk.

Main Methods:

Analysis of a prospective multicenter cohort (Lung Transplant Outcomes Group) of 2386 adult lung recipients.
Definition of probable CLAD using International Society for Heart and Lung Transplantation criteria.
Cox models adjusted for covariates to assess time from CLAD onset to graft loss, examining CLAD stage, early onset, FVC loss, and FEV1/FVC ratio.

Main Results:

Probable CLAD occurred in 59.4% of patients; most presented with stage 1 CLAD and early onset.
Higher CLAD stage (≥2), early-onset CLAD, and FVC loss were significantly associated with increased hazard of graft loss.
A reduced FEV1/FVC ratio (<0.7) was paradoxically associated with a lower risk of graft loss.

Conclusions:

Routine, objective clinical measures at CLAD onset effectively predict progression to graft loss.
Stratifying CLAD based on objective measures is crucial for patient prognostication.
These findings can inform the design of future clinical trials for CLAD interventions.