Current views on chronic rejection after lung transplantation

GM Verleden, R Vos, B Vanaudenaerde… - Transplant …, 2015 - Wiley Online Library
GM Verleden, R Vos, B Vanaudenaerde, L Dupont, J Yserbyt, D Van Raemdonck…
Transplant International, 2015Wiley Online Library
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 …
Summary
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.
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