Chronic Lung Allograft Dysfunction

Royer, Pierre‐Joseph; Olivera-Botello, Gustavo; Koutsokera, Angela; Aubert, John‐David; Bernasconi, Eric; Tissot, A. N.; Pison, Christophe; Nicod, Laurent P.; Boissel, Jean-Pièrre; Magnan, A.

doi:10.1097/tp.0000000000001215

Cited by 115 publications

(43 citation statements)

References 204 publications

(221 reference statements)

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“…Lung transplantation (LTx) exhibits the worst long-term survival of all solid organ transplantations, due to chronic rejection processes termed chronic lung allograft dysfunction (CLAD) (1). CLAD affects 50% of LTx recipients after 5 years and is the leading cause of long-term mortality after LTx (1,2). CLAD comprises clinically and histologically heterogeneous phenotypes (2), the most frequent of which is bronchiolitis obliterans syndrome (BOS).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of B cell–dependent lymphoid follicle formation prevents lymphocytic bronchiolitis after lung transplantation

Smirnova¹,

Conlon²,

Morrone³

et al. 2019

JCI Insight

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Section: Introductionmentioning

confidence: 99%

Inhibition of B cell–dependent lymphoid follicle formation prevents lymphocytic bronchiolitis after lung transplantation

Smirnova¹,

Conlon²,

Morrone³

et al. 2019

JCI Insight

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“…Although the pathogenic mechanisms and the risk factors implicated in BOS and RAS are not fully elucidated (4, 11), recent literature provides increasing evidence and novel insights. Concerning BOS, most studies emphasize the role of multiple allo-immune and non-immune mechanisms (4, 11–13), but information on the risk factors of RAS or a comparative analysis of RAS and BOS is limited (10, 14).…”

Section: Introductionmentioning

confidence: 99%

“…Concerning BOS, most studies emphasize the role of multiple allo-immune and non-immune mechanisms (4, 11–13), but information on the risk factors of RAS or a comparative analysis of RAS and BOS is limited (10, 14). Identification of clinical risk factors associated with specific CLAD phenotypes is of particular clinical importance as it may assist patient risk stratification, optimize follow-up, or allow early intervention for potentially modifiable factors.…”

Section: Introductionmentioning

confidence: 99%

Development of a Multivariate Prediction Model for Early-Onset Bronchiolitis Obliterans Syndrome and Restrictive Allograft Syndrome in Lung Transplantation

Koutsokera¹,

Royer²,

Antonietti³

et al. 2017

Front. Med.

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BackgroundChronic lung allograft dysfunction and its main phenotypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), are major causes of mortality after lung transplantation (LT). RAS and early-onset BOS, developing within 3 years after LT, are associated with particularly inferior clinical outcomes. Prediction models for early-onset BOS and RAS have not been previously described.MethodsLT recipients of the French and Swiss transplant cohorts were eligible for inclusion in the SysCLAD cohort if they were alive with at least 2 years of follow-up but less than 3 years, or if they died or were retransplanted at any time less than 3 years. These patients were assessed for early-onset BOS, RAS, or stable allograft function by an adjudication committee. Baseline characteristics, data on surgery, immunosuppression, and year-1 follow-up were collected. Prediction models for BOS and RAS were developed using multivariate logistic regression and multivariate multinomial analysis.ResultsAmong patients fulfilling the eligibility criteria, we identified 149 stable, 51 BOS, and 30 RAS subjects. The best prediction model for early-onset BOS and RAS included the underlying diagnosis, induction treatment, immunosuppression, and year-1 class II donor-specific antibodies (DSAs). Within this model, class II DSAs were associated with BOS and RAS, whereas pre-LT diagnoses of interstitial lung disease and chronic obstructive pulmonary disease were associated with RAS.ConclusionAlthough these findings need further validation, results indicate that specific baseline and year-1 parameters may serve as predictors of BOS or RAS by 3 years post-LT. Their identification may allow intervention or guide risk stratification, aiming for an individualized patient management approach.

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“…Despite increased survival rates, lung transplant recipients still have a poor prognosis compared with other organ transplant patients [ 1 ]. Long-term survival is limited by the occurrence of chronic lung allograft dysfunction (CLAD), an umbrella term used to describe various pathophysiological processes affecting the allograft [ 2 ], among them bronchiolitis obliterans syndrome (BOS), the most common form of CLAD, and less frequently restrictive allograft syndrome (RAS), and/or a combination of the two [ 3 ]. As the detection of BOS enables immediate therapeutic intervention, early diagnosis is essential.…”

Section: Introductionmentioning

confidence: 99%

Combined diffusing capacity for nitric oxide and carbon monoxide as predictor of bronchiolitis obliterans syndrome following lung transplantation

et al. 2018

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BackgroundThere is a need for non-invasive parameters that are sensitive to the development of the bronchiolitis obliterans syndrome (BOS) in lung transplantation (LTx) patients. We studied whether the pulmonary diffusing capacity for inhaled nitric oxide is capable of detecting BOS stages.MethodsSixty-one LTx patients were included into this cross-sectional study (19/29/7/3/3 in BOS stages 0/0-p/1/2/3). For analysis stages 0/0-p versus 1/2/3 (“BOS binary-early”), and stages 0/0-p/1 versus 2/3 (“BOS binary-late”) were summarized. Measurements of the combined diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were compared with spirometry and bodyplethysmography, and their relative importance was evaluated by discriminant analysis.ResultsRegarding the recognition of “BOS binary-early”, among spirometric parameters forced expiratory volume in 1 s (FEV1) was best, among bodyplethysmographic parameters airway resistance, and among diffusing parameters DLNO. Regarding “BOS binary-late”, DLNO was inferior to bodyplethysmographic parameters.ConclusionAlthough the study comprised only measurements at a single time point and no follow-up, DLNO outperformed FEV1, the time course of which is used in detecting BOS. Together with its pathophysiological plausibility, this result suggests that the measurement of DLNO, possibly over time, could be an easily applicable tool for the monitoring of LTx patients and should be evaluated in larger studies.

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Chronic Lung Allograft Dysfunction

Cited by 115 publications

References 204 publications

Inhibition of B cell–dependent lymphoid follicle formation prevents lymphocytic bronchiolitis after lung transplantation

Inhibition of B cell–dependent lymphoid follicle formation prevents lymphocytic bronchiolitis after lung transplantation

Development of a Multivariate Prediction Model for Early-Onset Bronchiolitis Obliterans Syndrome and Restrictive Allograft Syndrome in Lung Transplantation

Combined diffusing capacity for nitric oxide and carbon monoxide as predictor of bronchiolitis obliterans syndrome following lung transplantation

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