Chronic lung allograft dysfunction in 2022, past and updates

Introduction. - While short-term results of lung transplantation have improved considerably, long-term survival remains below that achieved for other solid organ transplants.Current knowledge. - The main cause of late mortality is chronic lung allograft dysfunction (CLAD), which affects nearly half of the recipients 5 years after transplantation. Immunologi-cal and non-immune risk factors have been identified. These factors activate the innate and adaptive immune system, leading to lesional and altered wound-healing processes, which result in fibrosis affecting the small airways or interstitial tissue. Several phenotypes of CLAD have been identified based on respiratory function and imaging pattern. Aside from retransplanta-tion, which is possible for only small number of patients, no treatment can reverse the CLAD process.Perspectives. - Current therapeutic research is focused on anti-fibrotic treatments and photo-pheresis. Basic research has identified numerous biomarkers that could prove to be relevant as therapeutic targets.Conclusion. - While the pathophysiological mechanisms of CLAD are better understood than before, a major therapeutic challenge remains.(c) 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.