TY - JOUR
T1 - Chronic lung allograft dysfunction after lung transplantation
T2 - prevention, diagnosis and treatment in 44 European centres
AU - Gottlieb, Jens
AU - Vos, Robin
AU - Jaksch, Peter
AU - Hellemons, Merel
AU - Holm, Are Martin
AU - Morlacchi, Letizia Corinna
AU - Magnusson, Jesper
AU - Alonso Moralejo, Rodrigo
AU - Mora-Cuesta, Víctor M
AU - Ennekes, Vera
AU - Reed, Anna
AU - Merveilleux Du Vignaux, Claire
AU - Hettich, Ina
AU - Bennett, David
AU - Hecker, Matthias
AU - Wald, Alexandra
AU - Guk, Svitlana
AU - Skride, Andris
AU - Nolde, Anna
AU - Knoop, Christiane
AU - Meloni, Federica
AU - Tikkanen, Jussi
AU - Larsson, Hillevi
AU - Tissot, Adrien
AU - Riddell, Peter
AU - Le Pavec, Jérôme
AU - Perch, Michael
AU - Renaud-Picard, Benjamin
AU - Carlier, François M
AU - Müller, Veronika
AU - Parmar, Jasvir
AU - Havlin, Jan
AU - Laporta, Rosalía
AU - Schuurmans, Macé Matthew
AU - Harlander, Matevž
AU - Zenglen, Slavomir
AU - Brugiere, Olivier
AU - Kneidinger, Nikolaus
AU - Fisher, Andrew
AU - Saez-Gimenez, Berta
N1 - Publisher Copyright:
© The authors 2025.
PY - 2025/6/4
Y1 - 2025/6/4
N2 - BACKGROUND: There are limited data on optimal management of chronic lung allograft dysfunction (CLAD). We aimed to describe the variability of diagnostic and therapeutic practices in Europe.METHODS: A structured questionnaire was sent to 71 centres in 24 countries. Questions were related to contemporary clinical practices for workup, monitoring and treatment of CLAD. The number of lung transplant procedures and patients in follow-up were collected.RESULTS: 44 centres (62%) responded from 20 countries, representing 74% of European activity. The prevalence of CLAD was estimated at 9.1 cases per million population (25th and 75th percentiles of 4.4, 15.7). Preferred initial workup for probable CLAD consisted of chest computed tomography (CT) (inspiratory 91% and expiratory 74%), donor-specific antibody (DSA) measurement (86%), bronchoalveolar lavage (BAL) (85%) and transbronchial biopsy (81%). For monitoring of definite CLAD, inspiratory CT (67%), DSA (61%) and BAL (43%) were preferred. Body plethysmography was unavailable for 16% of cases. Prophylaxis was based on preventing infections (cytomegalovirus 99%, inhaled antibiotics 70% and antifungals 65%), tacrolimus-based immunosuppression (96%), azithromycin (72%) and universal proton pump inhibitor treatment (84%). First-line treatment of CLAD was based on azithromycin (82%) and steroid augmentation (74%). Photopheresis was used in 26% of cases.CONCLUSION: Current European practice CLAD detection is based on spirometry, inspiratory CT and DSA, with limited access to plethysmography and expiratory CT. Prophylactic treatment is based on azithromycin, tacrolimus-based immunosuppression and treatment of risk factors. No single treatment strategy is universally used, highlighting the need for an effective treatment of CLAD. The preferred first-line strategy is azithromycin and steroid augmentation.
AB - BACKGROUND: There are limited data on optimal management of chronic lung allograft dysfunction (CLAD). We aimed to describe the variability of diagnostic and therapeutic practices in Europe.METHODS: A structured questionnaire was sent to 71 centres in 24 countries. Questions were related to contemporary clinical practices for workup, monitoring and treatment of CLAD. The number of lung transplant procedures and patients in follow-up were collected.RESULTS: 44 centres (62%) responded from 20 countries, representing 74% of European activity. The prevalence of CLAD was estimated at 9.1 cases per million population (25th and 75th percentiles of 4.4, 15.7). Preferred initial workup for probable CLAD consisted of chest computed tomography (CT) (inspiratory 91% and expiratory 74%), donor-specific antibody (DSA) measurement (86%), bronchoalveolar lavage (BAL) (85%) and transbronchial biopsy (81%). For monitoring of definite CLAD, inspiratory CT (67%), DSA (61%) and BAL (43%) were preferred. Body plethysmography was unavailable for 16% of cases. Prophylaxis was based on preventing infections (cytomegalovirus 99%, inhaled antibiotics 70% and antifungals 65%), tacrolimus-based immunosuppression (96%), azithromycin (72%) and universal proton pump inhibitor treatment (84%). First-line treatment of CLAD was based on azithromycin (82%) and steroid augmentation (74%). Photopheresis was used in 26% of cases.CONCLUSION: Current European practice CLAD detection is based on spirometry, inspiratory CT and DSA, with limited access to plethysmography and expiratory CT. Prophylactic treatment is based on azithromycin, tacrolimus-based immunosuppression and treatment of risk factors. No single treatment strategy is universally used, highlighting the need for an effective treatment of CLAD. The preferred first-line strategy is azithromycin and steroid augmentation.
UR - http://www.scopus.com/inward/record.url?scp=105008238745&partnerID=8YFLogxK
U2 - 10.1183/23120541.00675-2024
DO - 10.1183/23120541.00675-2024
M3 - Article
C2 - 40470157
SN - 2312-0541
VL - 11
SP - 1
EP - 11
JO - ERJ Open Research
JF - ERJ Open Research
IS - 3
M1 - 00675-2024
ER -