Routine care practices for stable lung allograft recipients beyond the initial post-transplant year: An international...

The pragmatic aspects of routine lung transplant recipient management are poorly described. We performed an international survey study to characterize management of stable lung transplant recipients who are beyond the initial post-transplant year. We obtained survey responses from 72 distinct lung transplant programs in 15 countries. Stable patients are monitored a median of every 3-months (IQR 3-3.25) in the ambulatory setting. Visits are accompanied by diagnostic laboratory assessments, spirometry, and chest X-ray imaging. Most centers perform between-clinic surveillance every 1-month (IQR 1-1.5) with diagnostic laboratory testing. We identified the frequency of monitoring of donor-specific antibodies [median 6 months (IQR 3-6)], chest computed tomography [median 12 months (IQR 12-12)], and other ancillary testing. A majority of stable patients are managed on a maintenance immunosuppression regimen of tacrolimus (preferred goal trough 8-10 ng/ml), mycophenolate, and prednisone (preferred dose of 5 mg daily). Dose reduction of immunosuppression occurs for cytopenias, recurrent infection, malignancy, and short telomere syndromes at most centers. Methodologies and frequencies for malignancy screening are described. While routine care of lung transplant recipients is heterogeneous, there are potential areas of consensus in practice patterns.