When tissue is the issue: A histological review of chronic lung allograft dysfunction. Issue 10 (15th April 2020)

• Record Type: Journal Article
• Authors: Verleden, Stijn E.; Von der Thüsen, Jan; Roux, Antoine; Brouwers, Emily S.; Braubach, Peter; Kuehnel, Mark; Laenger, Florian; Jonigk, Danny
• Is Part Of: American journal of transplantation. Volume 20:Issue 10(2020)
• Page Start: 2644
• Page End: 2651
• Publication Date: 2020-04-15
• Subjects: biopsy -- bronchiolitis obliterans (BOS) -- lung (allograft) function/dysfunction -- lung transplantation/pulmonology -- pathology/histopathology -- rejection: antibody‐mediated (ABMR) -- rejection: chronic -- translational research/science; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15864
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Although chronic lung allograft dysfunction (CLAD) remains the major life‐limiting factor following lung transplantation, much of its pathophysiology remains unknown. The discovery that CLAD can manifest both clinically and morphologically in vastly different ways led to the definition of distinct subtypes of CLAD. In this review, recent advances in our understanding of the pathophysiological mechanisms of the different phenotypes of CLAD will be discussed with a particular focus on tissue‐based and molecular studies. An overview of the current knowledge on the mechanisms of the airway‐centered bronchiolitis obliterans syndrome, as well as the airway and alveolar injuries in the restrictive allograft syndrome and also the vascular compartment in chronic antibody‐mediated rejection is provided. Specific attention is also given to morphological and molecular markers for early CLAD diagnosis or histological changes associated with subsequent CLAD development. Evidence for a possible overlap between different forms of CLAD is presented and discussed. In the end, "tissue remains the (main) issue, " as we are still limited in our knowledge about the actual triggers and specific mechanisms of all late forms of posttransplant graft failure, a shortcoming that needs to be addressed in order to further improve the outcome of lung transplant recipients. Abstract : This minireview summarizes the different presentations of chronic lung allograft dysfunction, focusing on histopathological and molecular aspects of bronchiolitis obliterans syndrome, restrictive allograft syndrome, and antibody‐mediated rejection.