Chronic lung allograft dysfunction

The recognition that chronic graft dysfunction after lung transplantation is a heterogeneous phenomenon has led to the introduction of a new term: chronic lung allograft dysfunction (CLAD). An International Society for Heart and Lung Transplantation working group will determine a definition of CLAD in 2014. It is thought that CLAD should not totally replace bronchiolitis obliterans syndrome (BOS), the conventional phenotype of chronic graft dysfunction, but that it should be a more comprehensive category that includes BOS as a purely obstructive disorder. Another phenotype to be included is restrictive allograft syndrome, a restrictive form of graft dysfunction that is distinct from BOS. Neutrophilic reversible allograft dysfunction may be included in CLAD as well. Further discussion is required before including other conditions associated with impaired pulmonary function after transplantation. Recent progress in the management of patients with CLAD includes the development of a series of diagnostic tests and recognition of the benefits of a trial of low-dose azithromycin. Further refinement of our understanding of the pathophysiology of CLAD and clinical care pathways is necessary.