title: Predictors of survival in restrictive chronic lung allograft dysfunction after lung transplantation.
abstract: Chronic lung allograft dysfunction (CLAD) is the main factor limiting long-term survival after lung transplantation. Besides bronchiolitis obliterans syndrome, a restrictive phenotype of CLAD (rCLAD) exists, which is associated with poor prognosis after diagnosis. However, survival determinants for rCLAD remain to be elucidated. Our aim in this study was to establish parameters predicting survival in patients with rCLAD.
  
  
  
  All patients diagnosed with rCLAD in 2 lung transplant centers were assessed in a retrospective manner. Various clinical parameters [demography, pulmonary function, bronchoalveolar lavage (BAL), histopathology, radiology and blood differentials] at rCLAD diagnosis were correlated with graft survival using unadjusted and adjusted analysis.
  
  
  
  A total of 53 patients with rCLAD were included with a median graft survival after diagnosis of 1.1 years. Univariate analysis demonstrated that lower-lobe-dominant or diffuse infiltrates on chest computed tomography, presence of an identifiable trigger before rCLAD onset, lymphocytic bronchiolitis, increased BAL neutrophilia, increased BAL eosinophilia and increased blood eosinophils were associated with inferior graft survival after rCLAD diagnosis. Multivariate analysis confirmed the association of location of infiltrates and blood eosinophilia on graft survival.
  
  
  
  In this study we have identified parameters associated with graft survival after rCLAD diagnosis that may be useful to predict prognosis.
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium. Electronic address: stijn.verleden@med.kuleuven.be.
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Ruttens
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Elly
authors.initials: E
authors.lastname: Vandermeulen
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Bellon
authors.affiliation: Radiology Unit, University Hospital Leuven, Leuven, Belgium.
authors.forename: Adriana
authors.initials: A
authors.lastname: Dubbeldam
authors.affiliation: Radiology Unit, University Hospital Leuven, Leuven, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: De Wever
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Lieven J
authors.initials: LJ
authors.lastname: Dupont
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.affiliation: Leuven Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
mesh_terms: D064591:Allografts; D001989:Bronchiolitis Obliterans; D006084:Graft Rejection; D006801:Humans; D016040:Lung Transplantation; D012189:Retrospective Studies; D014184:Transplantation, Homologous
keywords: chronic lung allograft dysfunction; computed tomography; eosinophils; restrictive allograft syndrome; upper lobe fibrosis