Robin Vos1, Stijn E Verleden, Geert M Verleden. 1. Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven and UZ Leuven, Leuven, Belgium.
Abstract
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
Authors: Dirk Van Raemdonck; Robin Vos; Jonas Yserbyt; Herbert Decaluwe; Paul De Leyn; Geert M Verleden Journal: J Thorac Dis Date: 2016-11 Impact factor: 2.895
Authors: Danny Jonigk; Berenice Rath; Paul Borchert; Peter Braubach; Lavinia Maegel; Nicole Izykowski; Gregor Warnecke; Wiebke Sommer; Hans Kreipe; Robert Blach; Adrian Anklamm; Axel Haverich; Matthias Eder; Michael Stadler; Tobias Welte; Jens Gottlieb; Mark Kuehnel; Florian Laenger Journal: J Pathol Clin Res Date: 2016-12-10
Authors: David Ruttens; Stijn E Verleden; Heleen Demeyer; Dirk E Van Raemdonck; Jonas Yserbyt; Lieven J Dupont; Bart M Vanaudenaerde; Robin Vos; Geert M Verleden Journal: PLoS One Date: 2018-04-06 Impact factor: 3.240
Authors: Joshua Y C Yang; Stijn E Verleden; Arya Zarinsefat; Bart M Vanaudenaerde; Robin Vos; Geert M Verleden; Reuben D Sarwal; Tara K Sigdel; Juliane M Liberto; Izabella Damm; Drew Watson; Minnie M Sarwal Journal: J Clin Med Date: 2019-02-13 Impact factor: 4.241