Chronic lung allograft dysfunction: evolving practice.
OBJECTIVE
Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term covering different phenotypes of chronic allograft dysfunction, including obstructive CLAD (bronchiolitis obliterans syndrome), restrictive CLAD (restrictive allograft syndrome) and graft dysfunction due to causes not related to chronic rejection. In the present review, we will highlight the latest insights and current controversies regarding the new CLAD terminology, underlying pathophysiologic mechanisms, diagnostic approach and possible treatment options.


RESULTS
Different pathophysiological mechanisms are clearly involved in clinically distinct phenotypes of chronic rejection, as is reflected by differences in histology, allograft function and imaging. Therefore, not all CLAD patients may equally benefit from specific therapies.


CONCLUSIONS
The recent introduction of CLAD importantly changed the clinical practice in lung transplant recipients. Given the relative low accuracy of the current diagnostic tools, future research should focus on specific biomarkers, more sensitive pulmonary function parameters and imaging techniques for timely CLAD diagnosis and phenotyping. Personalized or targeted therapeutic options for adequate prevention and treatment of CLAD are required.
Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven and UZ Leuven, Leuven, Belgium.
Robin
R
Vos
Stijn E
SE
Verleden
Geert M
GM
Verleden
D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000503:physiopathology; D002908:Chronic Disease; D006801:Humans; D008168:Lung / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects; D012307:Risk Factors; D014184:Transplantation, Homologous