Scientific article

Significance of phenotype change after chronic lung allograft dysfunction onset

Published inTransplant international, vol. 34, no. 12, p. 2620-2632
Publication date2021-12
First online date2021-11-16

Definitions for chronic lung allograft dysfunction (CLAD) phenotypes were recently revised (2019 ISHLT consensus). Post-CLAD onset phenotype transition may occur as a result of change in obstruction, restriction, or RAS-like opacities (RLO). We aimed to assess the prevalence and prognostic implications of these transitions. This was a single-center, retrospective cohort study of bilateral lung transplants performed in 2009-2015. CLAD phenotypes were determined per ISHLT guidelines. CLAD phenotype transition was defined as a sustained change in obstruction, restriction or RLO. We specifically focused on phenotype changes based on RLO emergence. Association of RLO development with time to death or retransplant were assessed using Kaplan-Meier and Cox proportional hazards models. Among 211 patients with CLAD, 47 (22.2%) experienced a phenotype transition. Nineteen patients developed RLO. Development of RLO phenotype after CLAD onset was associated with a shorter time to death/retransplant when considering the entire CLAD patient cohort (HR = 4.00, CI 2.74-5.83, P < 0.001) and also when restricting the analysis to only patients with a Non-RLO phenotype at CLAD onset (HR 9.64, CI 5.52-16.84, P < 0.0001). CLAD phenotype change based on emergence of RAS-like opacities implies a worse outcome. This highlights the clinical importance of imaging follow-up to monitor for phenotype transitions after CLAD onset.

  • Chronic lung allograft dysfunction
  • Lung transplantation
  • Phenotype change
  • Allografts
  • Humans
  • Lung
  • Lung Transplantation / adverse effects
  • Phenotype
  • Primary Graft Dysfunction / epidemiology
  • Primary Graft Dysfunction / etiology
  • Retrospective Studies
Affiliation Not a UNIGE publication
Citation (ISO format)
FUCHS, Eyal et al. Significance of phenotype change after chronic lung allograft dysfunction onset. In: Transplant international, 2021, vol. 34, n° 12, p. 2620–2632. doi: 10.1111/tri.14157
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Article (Published version)
ISSN of the journal0934-0874

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