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Management of chronic rejection after lung transplantation.
| Content Provider | Europe PMC |
|---|---|
| Author | Bedair, Bahaa Hachem, Ramsey R. |
| Copyright Year | 2021 |
| Abstract | Outcomes after lung transplantation are limited by chronic lung allograft dysfunction (CLAD). The incidence of CLAD is high, and its clinical course tends to be progressive over time, culminating in graft failure and death. Indeed, CLAD is the leading cause of death beyond the first year after lung transplantation. Therapy for CLAD has been limited by a lack of high-quality studies to guide management. In this review, we will discuss the diagnosis of CLAD in light of the recent changes to definitions and will discuss the current clinical evidence available for treatment. Recently, the diagnosis of CLAD has been subdivided into bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). The current evidence for treatment of CLAD mainly revolves around treatment of BOS with more limited data existing for RAS. The best supported treatment to date for CLAD is the macrolide antibiotic azithromycin which has been associated with a small improvement in lung function in a minority of patients. Other therapies that have more limited data include switching immunosuppression from cyclosporine to tacrolimus, fundoplication for gastroesophageal reflux, montelukast, extracorporeal photopheresis (ECP), aerosolized cyclosporine, cytolytic anti-lymphocyte therapies, total lymphoid irradiation (TLI) and the antifibrotic agent pirfenidone. Most of these treatments are supported by case series and observational studies. Finally, we will discuss the role of retransplantation for CLAD. |
| ISSN | 20721439 |
| Journal | Journal of Thoracic Disease |
| Volume Number | 13 |
| PubMed Central reference number | PMC8662511 |
| Issue Number | 11 |
| PubMed reference number | 34992842 |
| e-ISSN | 20776624 |
| DOI | 10.21037/jtd-2021-19 |
| Language | English |
| Publisher | AME Publishing Company |
| Publisher Date | 2021-11-01 |
| Access Restriction | Open |
| Rights License | Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0. 2021 Journal of Thoracic Disease. All rights reserved. |
| Subject Keyword | Chronic rejection chronic lung allograft dysfunction bronchiolitis obliterans syndrome restrictive allograft syndrome |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine |
