Kind
Papers
Key publications and preprints, each with a verified DOI.
Paper
Donor-derived cell-free DNA predicts allograft failure and mortality after lung transplantation
Evidence: prospective multicentre cohort; abstract-only
A multicentre prospective cohort of 106 lung transplant recipients linking early donor-derived cell-free DNA to later allograft failure, including severe CLAD.
Paper
Clinical predictors for restrictive allograft syndrome: A nested case-control study.
Evidence: retrospective nested case-control study; abstract-only
A KU Leuven nested case-control study of 69 patients with RAS and 69 matched controls without CLAD, identifying clinical features reported to be associated with later RAS.
Paper
A transcriptomic atlas of chronic lung allograft dysfunction.
Evidence: human tissue transcriptomic study with multi-dataset validation; abstract-only
A KU Leuven-affiliated imaging-based gene expression study of 128 lung samples from explanted CLAD and donor lungs, reporting two transcriptomic CLAD endotypes and a 26-gene panel.
Paper
Airway Microbiota Determines Innate Cell Inflammatory or Tissue Remodeling Profiles in Lung Transplantation
Evidence: observational study with laboratory assays; abstract-only
In lavage samples from 112 lung transplant recipients, airway bacterial communities aligned with macrophage inflammatory or remodelling gene profiles.
Paper
Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection
Evidence: prospective cross-sectional study; abstract-only
Reflux and gastric aspiration were common in lung transplant recipients, and bile acids in lavage fluid, but not pepsin, were more frequent in those with BOS.
Paper
IL-17-dependent cellular immunity to collagen type V predisposes to obliterative bronchiolitis in human lung transplants
Evidence: prospective immunological cohort; abstract-only
Immune cell responses to collagen type V, driven by IL-17 and monocytes, were linked to more frequent and more severe BOS in lung transplant recipients.
Paper
CLAD: translating basic science to clinical practice
Evidence: review-abstract-only
A narrative review in the Journal of Heart and Lung Transplantation, published online 9 October 2026, that proposes classifying CLAD by biological endotypes. Only the abstract was read.
Paper
Macrophage and CD8 T cell discordance are associated with acute lung allograft dysfunction progression
Evidence: prospective single-cell RNA sequencing cohort; abstract-only
Lavage cell sequencing in 45 recipients found a macrophage cluster and a CD8 T cell cluster that distinguished ALAD with later decline from ALAD that recovered or stable function.
Paper
Eosinophils in transbronchial biopsies: a predictor of chronic lung allograft dysfunction and reduced survival after lung transplantation — a retrospective single‐center cohort study.
Evidence: retrospective single-centre cohort (1,440 patients); abstract-only
A Toronto cohort of 1,440 recipients in which eosinophils reported on transbronchial biopsy were associated with higher hazards of CLAD and death.
Paper
Impact of Immediate Primary Lung Allograft Dysfunction on Bronchiolitis Obliterans Syndrome.
Evidence: retrospective single-centre cohort (334 recipients); abstract-only
A single-centre cohort of 334 lung transplant recipients reporting that primary graft dysfunction was associated with a higher risk of BOS, increasing with its grade.
Paper
Long-term Outcomes of Lung Transplant With Ex Vivo Lung Perfusion
Evidence: retrospective single-centre cohort; abstract-only
A Toronto cohort study comparing long-term CLAD incidence and allograft survival after transplant with and without ex vivo lung perfusion (EVLP).
Paper
Identification and characterization of inflammatory LILR and fibrotic SPP1 macrophages in chronic lung allograft dysfunction
A bioRxiv preprint (version 1, posted 9 September 2026) reporting two macrophage populations in CLAD, with SPP1 macrophages selectively enriched in RAS.
Paper
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
The 2002 ISHLT update of the diagnostic criteria for bronchiolitis obliterans syndrome, which preceded the 2019 CLAD framework.
Paper
Prognostic validation of the 2019 International Society for Heart and Lung Transplantation chronic lung allograft dysfunction states in lung allograft recipients
A 2026 open-access study of 482 recipients that tested the 2019 ISHLT CLAD states against mortality.
Paper
Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome: A consensus report from the Pulmonary Council of the ISHLT
The companion 2019 ISHLT consensus report, published in the same issue, that gives a definition and update of restrictive allograft syndrome.
Paper
Antibodies to K-α 1 Tubulin and Collagen V Are Associated With Chronic Rejection After Lung Transplantation
Evidence: retrospective cohort; abstract-only
Antibodies to two lung self-proteins, K-alpha 1 tubulin and collagen V, were associated with later bronchiolitis obliterans syndrome (BOS) in a retrospective study of 108 lung transplant recipients.
Paper
Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival.
Evidence: retrospective single-centre imaging study (74 patients); abstract-only
A Toronto retrospective study of quantitative chest CT density in 74 patients at CLAD onset, reporting that higher density values were associated with shorter survival.
Paper
Distinct fibrotic, epithelial and immune transcriptomic programs in phenotypes of chronic lung allograft dysfunction
Evidence: preprint; human cohort (bulk RNA-seq of explanted lungs)
A bioRxiv preprint (version 1, posted 28 May 2026, not peer reviewed) reporting bulk RNA sequencing of explanted lungs from 45 recipients with end-stage CLAD compared with control and IPF lungs.
Paper
Toward molecular endotypes of CLAD: dancing around the truth hidden in the tissue
Evidence: editorial; full text not read
A single-author editorial by Stephen Juvet in the European Respiratory Journal, published online 9 October 2026. Full text not read; content unconfirmed.
Paper
Higher Molecular Injury at Diagnosis of Acute Cellular Rejection Increases the Risk of Lung Allograft Failure: A Clinical Trial
Evidence: prospective multicentre cohort (registered clinical trial); abstract-only
In a prospective multicentre cohort of 188 lung transplant recipients, acute cellular rejection with higher donor-derived cell-free DNA was associated with a higher risk of CLAD or death.
Paper
JAK-STAT activation contributes to cytotoxic T cell-mediated basal cell death in human chronic lung allograft dysfunction
A 2023 JCI Insight paper on JAK-STAT activation and cytotoxic T cell-mediated basal cell death in human CLAD; its data are in GEO series GSE224210.
Paper
Epithelial cell death markers in bronchoalveolar lavage correlate with chronic lung allograft dysfunction subtypes and survival in lung transplant recipients-a single-center retrospective cohort study
Evidence: retrospective human biomarker study; abstract-only
A small retrospective study finding higher bronchoalveolar lavage M65 (a marker of epithelial cell death) in RAS than in BOS or CLAD-free controls.
Paper
Risk assessment of chronic lung allograft dysfunction phenotypes: Validation and proposed refinement of the 2019 International Society for Heart and Lung Transplantation classification system
Evidence: retrospective single-centre cohort; abstract-only
A single-centre cohort study that tested the 2019 ISHLT CLAD phenotype classification against survival after CLAD onset.
Paper
The impact of first untreated subclinical minimal acute rejection on risk for chronic lung allograft dysfunction or death after lung transplantation.
Evidence: retrospective single-centre cohort; abstract-only
A Toronto cohort study reporting no significant difference in the risk of CLAD or death between a first untreated, spirometrically stable A1 rejection episode and matched episodes without rejection.
Paper
An obligatory role for club cells in preventing obliterative bronchiolitis in lung transplants
Evidence: mouse lung transplant model; abstract-only
A mouse study reporting that club cells are needed to prevent obliterative bronchiolitis in transplanted lungs, and that CD8 T cells impair club cell repair.
Paper
Reprogramming alveolar macrophage responses to TGF-β reveals CCR2+ monocyte activity that promotes bronchiolitis obliterans syndrome
Evidence: mouse lung transplant model; abstract-only
A mouse study in which TGF-beta signalling in alveolar macrophages and CCR2-positive monocytes promoted BOS through expansion of CD8 T cells, with extracorporeal photopheresis blunting this pathway.
Paper
Phenotyping of chronic lung allograft dysfunction in the ScanCLAD study
A 2026 open-access study that phenotyped patients with CLAD within three years of transplantation using the 2019 ISHLT categories.
Paper
Spectrum of chronic lung allograft pathology in a mouse minor-mismatched orthotopic lung transplant model
Evidence: animal (mouse) study; abstract-only
A mouse lung transplant study describing a spectrum of CLAD-like pathology, including pleuroparenchymal fibroelastosis resembling human RAS.
Paper
Shared roles of immune and stromal cells in the pathogenesis of human bronchiolitis obliterans syndrome
Evidence: single-cell RNA sequencing study of explanted lungs; abstract-only
Single-cell sequencing of explanted lungs from 4 patients with CLAD-BOS, 3 with chronic graft-versus-host-disease BOS and 3 controls found an expanded CD8 tissue-resident memory T cell population.
Paper
An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome
Evidence: guideline; abstract-only
An international guideline from ISHLT, ATS and ERS on the definition, risk factors, diagnosis and management of bronchiolitis obliterans syndrome (BOS).
Paper
Local intragraft humoral immune responses in chronic lung allograft dysfunction.
Evidence: human tissue laboratory study (15 CLAD patients); abstract-only
A Toronto laboratory study of lung tissue from 15 CLAD patients, reporting that donor-specific and non-HLA antibodies can be produced within the lung allograft.
Paper
Periostin defines a pathological fibroblast program enriched in restrictive allograft syndrome
A 2026 JCI Insight paper on a periostin-defined fibroblast program in restrictive allograft syndrome; its single-cell data are in GEO series GSE325801.
Paper
Interferon-stimulated and metallothionein-expressing macrophages are associated with acute and chronic allograft dysfunction after lung transplantation
Evidence: single-cell RNA sequencing study; abstract-only
Single-cell sequencing of lavage cells found two macrophage subsets, interferon-stimulated and metallothionein-expressing, linked to acute lung allograft dysfunction and also seen in explanted CLAD lungs.
Paper
Restrictive allograft syndrome post lung transplantation is characterized by pleuroparenchymal fibroelastosis
Evidence: retrospective human tissue study; abstract-only
A histopathology study reporting pleuroparenchymal fibroelastosis as a major tissue correlate of restrictive allograft syndrome.
Paper
Transcripts associated with chronic lung allograft dysfunction in transbronchial biopsies of lung transplants
A 2022 American Journal of Transplantation paper on gene transcripts associated with CLAD in transbronchial biopsies; its data are in GEO series GSE193150.
Paper
Community-acquired Respiratory Viruses Are a Risk Factor for Chronic Lung Allograft Dysfunction.
Evidence: prospective single-centre cohort (98 recipients); abstract-only
A prospective Barcelona cohort of 98 lung transplant recipients reporting that lower respiratory tract infection with community-acquired respiratory viruses was an independent risk factor for CLAD.
Paper
Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients.
Evidence: retrospective single-centre cohort (487 recipients); abstract-only
A Toronto cohort of 487 lung transplant recipients in which oesophageal outflow obstruction and major peristalsis disorders were associated with a higher hazard of CLAD and allograft failure.
Paper
Spectrum of chronic lung allograft dysfunction pathology in human lung transplantation.
Evidence: human explant histology study (20 CLAD patients, 13 controls); abstract-only
A Toronto histology study of explanted lungs from 20 patients retransplanted for CLAD, reporting a wide overlap between BOS and RAS pathology.
Paper
Reduced lung fluid club cell secretory protein informs chronic lung allograft dysfunction risk
Evidence: prospective observational validation cohort; abstract-only
A validation study in 353 lung recipients that did not confirm the earlier lavage CCSP threshold on its own, but found the association with CLAD risk in the combined cohorts.
Paper
Restrictive allograft syndrome (RAS): A novel form of chronic lung allograft dysfunction
The 2011 description of restrictive allograft syndrome as a form of chronic lung allograft dysfunction.
Paper
Bronchiolitis obliterans syndrome and restrictive allograft syndrome after lung transplantation: why are there two distinct forms of chronic lung allograft dysfunction?
An open-access 2020 review asking why chronic lung allograft dysfunction presents as two distinct forms, BOS and RAS.
Paper
Circulating exosomes with lung self-antigens as a biomarker for chronic lung allograft dysfunction: A retrospective analysis
Evidence: retrospective multicentre biomarker study; abstract-only
A retrospective study reporting that blood exosomes carrying lung self-antigens were raised up to 12 months before a diagnosis of BOS-type chronic rejection.
Paper
Cytomegalovirus Pneumonitis Is a Risk for Bronchiolitis Obliterans Syndrome in Lung Transplantation.
Evidence: retrospective single-centre cohort (231 recipients); abstract-only
A single-centre cohort of 231 lung transplant recipients reporting that treated cytomegalovirus pneumonitis was associated with a higher hazard of BOS and death.
Paper
De Novo DQ Donor-Specific Antibodies Are Associated with Chronic Lung Allograft Dysfunction after Lung Transplantation
Evidence: retrospective single-centre cohort; abstract-only
A single-centre cohort of 340 lung transplant recipients reporting that de novo DQ donor-specific antibodies are associated with CLAD.
Paper
Hyaluronan Contributes to Bronchiolitis Obliterans Syndrome and Stimulates Lung Allograft Rejection through Activation of Innate Immunity
Evidence: clinical sample analysis with mouse lung transplant experiments; abstract-only
Hyaluronan was raised in recipients with BOS, and in mice it stimulated lung allograft rejection through innate immune signalling.
Paper
Early posttransplant reductions in club cell secretory protein associate with future risk for chronic allograft dysfunction in lung recipients: results from a multicenter study
Evidence: multicentre cohort study; abstract-only
In 392 lung recipients at five centres, lower club cell secretory protein in lavage fluid during the first year after transplant was associated with a higher later risk of probable CLAD.
Paper
Azithromycin reduces airway neutrophilia and interleukin-8 in patients with bronchiolitis obliterans syndrome
Evidence: small uncontrolled human study; abstract-only
A small 2006 study of 14 patients with BOS that measured airway neutrophils and interleukin-8 before and after azithromycin.
Paper
Survival determinants in lung transplant patients with chronic allograft dysfunction
Evidence: retrospective single-centre cohort; abstract-only
A single-centre retrospective study of survival determinants after a diagnosis of CLAD, reporting about 28 percent with a restrictive pattern.
Paper
Bronchiolitis obliterans syndrome and restrictive allograft syndrome: do risk factors differ?
Evidence: retrospective single-centre cohort; abstract-only
A retrospective cohort comparison of risk factors for BOS and RAS, finding largely overlapping associations.
Paper
A new classification system for chronic lung allograft dysfunction
Evidence: proposal or perspective; abstract-only
A 2014 proposal of a definition of chronic lung allograft dysfunction (CLAD) and a flow chart for recognising its phenotypes.
Paper
Impact of CLAD Phenotype on Survival After Lung Retransplantation: A Multicenter Study
Evidence: retrospective multicentre cohort; abstract-only
A four-centre retrospective study comparing survival after retransplantation for BOS with survival after retransplantation for restrictive CLAD.
Paper
Restrictive chronic lung allograft dysfunction: Where are we now?
Evidence: narrative perspective; abstract-only
A 2015 perspective reviewing what was known about restrictive CLAD, including diagnosis, imaging, pathology, prognosis and gaps.
Paper
Chronic lung allograft dysfunction phenotypes and treatment
Evidence: narrative review; abstract-only
A 2017 review of the BOS and RAS phenotypes of CLAD, their features and risk factors, and treatment strategies that have been tried.
Paper
Donor-specific and -nonspecific HLA antibodies and outcome post lung transplantation
Evidence: retrospective single-centre cohort; abstract-only
A cohort study of 362 patients linking donor-specific HLA antibodies, especially persistent ones, to shorter CLAD-free survival and to restrictive CLAD.
Paper
Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment: A consensus report from the Pulmonary Council of the ISHLT
The 2019 ISHLT Pulmonary Council consensus report that defines chronic lung allograft dysfunction and sets out diagnostic criteria and approaches to treatment.
Paper
Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?
Evidence: retrospective single-centre cohort (92 recipients); abstract-only
A Leuven retrospective study of 92 double lung recipients reporting an association between pseudomonal airway colonisation after transplant and BOS.
Paper
Humoral immunity to lung antigens early post-transplant confers risk for chronic lung allograft dysfunction.
Evidence: retrospective single-centre cohort (89 recipients); abstract-only
A single-centre Toronto study of 89 bilateral lung transplant recipients reporting that certain autoantibodies at 6 months after transplant, and de novo donor-specific antibodies, were associated with CLAD.
Paper
Chronic lung allograft dysfunction is associated with an increased number of non-HLA antibodies
Evidence: retrospective multicentre cohort; abstract-only
In a five-centre retrospective study of 226 lung transplant recipients, having several non-HLA antibodies was associated with a higher risk of CLAD.
Paper
Single-cell dissection of chronic lung allograft dysfunction reveals convergent and distinct fibrotic mechanisms
Evidence: single-cell transcriptomic analysis of explanted lungs with cross-disease integration; abstract-only
A single-cell analysis of CLAD lungs integrated with data from other fibrotic lung diseases, reporting CLAD-specific cell subsets and a shared KRT17-positive, KRT5-negative cell population.
Paper
Chronic lung allograft dysfunction post-lung transplantation: The era of bronchiolitis obliterans syndrome and restrictive allograft syndrome
An open-access 2020 review that summarises the CLAD definition, the phenotype table and the risk factors discussed for BOS and RAS.