Chronic lung allograft dysfunction

Last revised by Yuranga Weerakkody on 3 Jan 2023

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: 

  • obstructive, which represents the bronchiolitis obliterans syndrome (BOS) with a picture of small airway obstruction 2,3

  • 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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