TY - JOUR
T1 - Significance of phenotype change after chronic lung allograft dysfunction onset
AU - Fuchs, Eyal
AU - Levy, Liran
AU - Huszti, Ella
AU - Renaud-Picard, Benjamin
AU - Berra, Gregory
AU - Kawashima, Mitsuaki
AU - Takahagi, Akihiro
AU - Ghany, Rasheed
AU - Havlin, Jan
AU - McInnis, Micheal C.
AU - Keshavjee, Shaf
AU - Singer, Lianne G.
AU - Tikkanen, Jussi
AU - Chow, Chung Wai
AU - Martinu, Tereza
N1 - Publisher Copyright:
© 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85119074837&partnerID=8YFLogxK
U2 - 10.1111/tri.14157
DO - 10.1111/tri.14157
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C2 - 34748217
AN - SCOPUS:85119074837
SN - 0934-0874
VL - 34
SP - 2620
EP - 2632
JO - Transplant International
JF - Transplant International
IS - 12
ER -