Approach to prevention and management of chronic lung allograft dysfunction in North American lung transplant centers

Chronic lung allograft dysfunction (CLAD) is the major barrier to long-term survival after lung transplantation, but literature documenting contemporary practice patterns and best practices for management are lacking. We sought to characterize monitoring and lung function-dependent management strategies across adult North American lung transplant centers. A RedCap survey was distributed to 21 centers accounting for nearly half of North American lung transplants. Routine immunosuppression and post-transplant graft monitoring protocols were similar among centers. Prophylactic azithromycin was routinely used by 7 (33.3%) centers, and respondents had substantial uncertainty regarding its effectiveness. A persistent ≥10% FEV_₁ decline was considered clinically meaningful by most centers and triggered similar evaluations, including bronchoscopy, DSA testing, and chest CT. However, both the lung function thresholds prompting intervention and specific therapeutic strategies varied substantially. These findings highlight significant heterogeneity in CLAD management and support the need for prospective studies to inform evidence-based approaches.