title: Current views on chronic rejection after lung transplantation.
abstract: Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term mainly to classify patients with chronic rejection after lung transplantation, although other conditions may also qualify for CLAD. Initially, only the development of a persistent and obstructive pulmonary function defect, clinically identified as bronchiolitis obliterans syndrome (BOS), was considered as chronic rejection, if no other cause could be identified. It became clear in recent years that some patients do not qualify for this definition, although they developed a chronic and persistent decrease in FEV1 , without another identifiable cause. As the pulmonary function decline in these patients was rather restrictive, this was called restrictive allograft syndrome (RAS). In the present review, we will further elaborate on these two CLAD phenotypes, with specific attention to the diagnostic criteria, the role of pathology and imaging, the risk factors, outcome, and the possible treatment options.
authors: Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.|Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
authors: Geert M
authors: GM
authors: Verleden
authors: Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.|Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
authors: Robin
authors: R
authors: Vos
authors: Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.
authors: Bart
authors: B
authors: Vanaudenaerde
authors: Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.|Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
authors: Lieven
authors: L
authors: Dupont
authors: Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
authors: Jonas
authors: J
authors: Yserbyt
authors: Thoracic Surgery, Leuven, Belgium.
authors: Dirk
authors: D
authors: Van Raemdonck
authors: Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.
authors: Stijn
authors: S
authors: Verleden
mesh_terms: D064591:Allografts / Q000276:immunology; D017963:Azithromycin / Q000494:pharmacology / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002908:Chronic Disease; D018450:Disease Progression; D005541:Forced Expiratory Volume; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006084:Graft Rejection / Q000145:classification / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D016040:Lung Transplantation; D009504:Neutrophils / Q000187:drug effects; D010641:Phenotype; D011183:Postoperative Complications / Q000209:etiology
chemical_list: D017963:Azithromycin
keywords: azithromycin-responsive allograft dysfunction; bronchiolitis obliterans syndrome; chronic lung allograft dysfunction; chronic rejection; lung transplantation; restrictive allograft syndrome