Chronic lung allograft dysfunction (CLAD) is one of the late-stage post lung transplant complications. It is the most common cause of mortality in lung transplant recipients after the 1st year of transplantation 4.
Pathology
It is a clinical spirometric diagnosis characterized by an irreversible decline in the FEV1 of 20% or more relative to the highest post-transplant baseline representing one of the significant limitations in the survival of post-lung transplant patients.
It is considered an umbrella term that traditionally encompassed two different phenotypes:
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obstructive, which represents the bronchiolitis obliterans syndrome (BOS) with a picture of small airway obstruction 2,3
on imaging (HRCT), the major finding would be the presence of mosaic attenuation pattern and air trapping on an expiratory acquisition
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restrictive, also termed as restrictive allograft syndrome (RAS) or rCLAD, clinically showing restrictive functional lung changes due to a fibrotic process 2,3
on imaging (HRCT), it demonstrates persistent pleuroparenchymal infiltrates associated with marked lung volume loss compared to the baseline scans
These two phenotypes may evolve one to another along the post-transplant period 2.
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