Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single‐center study. Issue 2 (28th January 2020)

• Record Type: Journal Article
• Authors: Verleden, Stijn E.; Von Der Thüsen, Jan; Van Herck, Anke; Weynand, Birgit; Verbeken, Erik; Verschakelen, Johny; Dubbeldam, Adriana; Vanaudenaerde, Bart M.; Vos, Robin; Verleden, Geert M.
• Other Names: Dupont Lieven J investigator.; Yserbyt Jonas investigator.; Godinas Laurent investigator.; Vanstapel Arno investigator.; Sacreas Annelore investigator.; Kaes Janne investigator.; Heigl Tobias investigator.; Ordies Sofie investigator.; Neyrinck Arne P investigator.; Schaevers Veronique investigator.; De Leyn Paul investigator.; Van Raemdonck Dirk E investigator.; Coosemans Willy investigator.; Nafteux Philippe investigator.; Decaluwé Herbert investigator.; Van Veer Hans investigator.; Depypere Lieven investigator.; Frick Anna E investigator.; Ceulemans Laurens J investigator.
• Is Part Of: Clinical transplantation. Volume 34:Issue 2(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-01-28
• Subjects: bronchiolitis obliterans syndrome -- chronic lung allograft dysfunction -- lung transplantation -- mixed CLAD -- phenotypes -- restrictive allograft syndrome; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.13781
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Rationale: Patients can change chronic lung allograft dysfunction (CLAD) phenotype, especially from BOS to mixed phenotype. Our aim was to further characterize these patients. Method: Mixed CLAD was defined as a restrictive physiology with persistent CT opacities, after initial bronchiolitis obliterans syndrome (BOS) diagnosis. The incidence, prognosis, pulmonary function, radiology, pathology, and airway inflammation were compared between patients with restrictive allograft syndrome (RAS) and mixed CLAD. Result: A total of 268 (44%) patients developed CLAD of which 47 (18%) were diagnosed with RAS "ab initio, " 215 (80%) with BOS, and 6 (2%) an undefined phenotype. Twenty‐five patients developed a mixed CLAD phenotype (24 BOS to mixed and 1 RAS to mixed). Survival after mixed phenotype diagnosis was comparable ( P = .39) to RAS. More emphysema patients developed a mixed phenotype ( P = .020) compared to RAS ab initio, while mixed CLAD patients had a lower FEV1 ( P < .0001) and FEV1 /FVC ( P = .0002) at diagnosis compared to RAS ab initio. CT scans in patients with the mixed phenotype demonstrated apical predominance of the opacities ( P = .0034) with pleuroparenchymal fibroelastosis on histopathology. Conclusion: We further characterized patients with a mixed phenotype of CLAD. Although the survival after diagnosis was comparable to RAS ab initio patients, there was a difference in demography, pulmonary function, radiology, and pathology.