Clinical CLAD phenotypes are hard to assign reproducibly
Evidence level: proposed bottleneck; synthesis of abstract-level sources; pending approval
Adjudicators agreed poorly on phenotype in one single lung cohort, and reviews state that lung function alone cannot always identify the exact phenotype.
As of . Primary source: Berra et al., single lung phenotyping (DOI).
Summary
In 172 single lung recipients, agreement between two adjudicators was poor for CLAD phenotype (kappa 0.52) and moderate for CLAD diagnosis (kappa 0.69), and RAS-like opacities on imaging had the best agreement (kappa 0.73). A 2022 review states that precise phenotyping based on pulmonary function alone can be difficult and that chest imaging helps prognosis. A 2021 histology study of 52 BOS explants found varied lesions, including vasculopathy and fibrosis in many, not only obliterative bronchiolitis. The Leuven atlas abstract reports that samples from the same patient often diverged molecularly, which the authors say limits current phenotypical classification. The finding on single lung recipients may not apply to bilateral recipients.
Details
- barrier type
- classification
Sources and links
Related
Links from this record
- evidence: Phenotyping CLAD after single lung transplant: Limits and prognostic assessment of the 2019 ISHLT classification system
- evidence: Chronic lung allograft dysfunction and restrictive allograft syndrome: are phenotypes robust and helpful?
- evidence: Beyond Bronchiolitis Obliterans: In-Depth Histopathologic Characterization of Bronchiolitis Obliterans Syndrome after Lung Transplantation
- evidence: A transcriptomic atlas of chronic lung allograft dysfunction.
- evidence: Risk assessment of chronic lung allograft dysfunction phenotypes: Validation and proposed refinement of the 2019 International Society for Heart and Lung Transplantation classification system
- affects: ISHLT 2019 CLAD states: Potential, Possible, Probable and Definite
- affects: Bronchiolitis obliterans syndrome (BOS)
- affects: Restrictive allograft syndrome (RAS)
- affects: Mixed phenotype
- affects: Undefined phenotype
- affects: Chest CT: parenchymal patterns and density in CLAD
- affects: Molecular endotypes of CLAD (proposed framework)
Known gaps in this record
- interobserver agreement in bilateral recipients across centres (not found in the sources opened)
Information resource only. Not medical advice. Not a substitute for the care of the patient's transplant team.