Chronic Lung Allograft Dysfunction: More Than Meets the Eye?

PurposeCurrently, chronic lung allograft dysfunction (CLAD) is defined as the presence of an irreversible or partly reversible (to ≤ 80% baseline) decline in FEV1 compared with baseline values, persistent for at least 3 months. In established CLAD, total capacity (TLC) and chest computed tomography (CT) are required to determine CLAD phenotype, this has therapeutic prognostic significance. Current phenotypes comprise bronchiolitis obliterans syndrome (BOS), restrictive (RAS), Mixed, Undefined (in patients who do not fit either other phenotypes). However, some may present (> months) CT abnormalities suggestive injury/remodelling, without clear spirometric evidence physiologic impairment.MethodsWe report a series 7 transplant recipients demonstrating radiological comparable that seen (RAS/mixed), after exclusion underlying causes observed abnormalities, yet (significant) pulmonary function decline.ResultsAll had clear, signs however, qualifying formal diagnosis (i.e. ≥ 20% from baseline), but instead looming potential area (FEV1 10% even presenting normal spirometry on regular testing.ConclusionA subgroup atypically parenchymal/interstitial (‘RAS-like’) CT, phenotypic definition according current consensus. This warrants further reflection role detection interstitial disease transplantation, need during post-transplant follow-up, accuracy regarding physical characteristics. Currently, impairment. We decline. All testing. A