Significance of phenotype change after chronic lung allograft dysfunction onset. (16th November 2021)

• Record Type: Journal Article
• Authors: Fuchs, Eyal; Levy, Liran; Huszti, Ella; Renaud‐Picard, Benjamin; Berra, Gregory; Kawashima, Mitsuaki; Takahagi, Akihiro; Ghany, Rasheed; Havlin, Jan; McInnis, Micheal C.; Keshavjee, Shaf; Singer, Lianne G.; Tikkanen, Jussi; Chow, Chung‐Wai; Martinu, Tereza
• Is Part Of: Transplant international. Volume 34:Number 12(2021)
• Page Start: 2620
• Page End: 2632
• Publication Date: 2021-11-16
• Subjects: chronic lung allograft dysfunction -- lung transplantation -- phenotype change; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.14157
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: 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. Abstract : We assessed the prevalence and prognostic implications of post CLAD onset phenotype transitions in a large cohort of lung transplant recipients. We have shown that CLAD patients who later changed their phenotype due to the appearance of RAS‐like opacities had a significantly worse outcome. Potential event leading to these changes also described.