Phenotyping CLAD after single lung transplant: Limits and prognostic assessment of the 2019 ISHLT classification system

Summary

This retrospective study of adult first single lung transplants (2009 to 2017) had two independent adjudicators assess CLAD status and phenotype among 92 patients with a persistent FEV1 drop of at least 20 percent; 67 were diagnosed with CLAD. Interobserver agreement was moderate for CLAD diagnosis (kappa 0.69) and poor for phenotype (kappa 0.52); phenotypes were 31 BOS, 13 RAS, 2 mixed, 2 undefined and 19 unclassified. RAS was associated with higher risk of death or retransplant (HR 2.98), and RAS-like opacities on imaging were a strong predictor (HR 2.37) with the best agreement (kappa 0.73). The authors conclude that a classification relying on imaging performed better than one using published physiological cut-offs in single lung recipients.

Details

doi

10.1016/j.healun.2022.01.015

pmid

35351385

authors

Berra G, Huszti E, Levy L, Kawashima M, Fuchs E, Renaud-Picard B, Riddell P, Dias O, Rajagopala S, Ulahannan A, Ghany R, Singer LG, Tikkanen J, Martinu T

journal

The Journal of Heart and Lung Transplantation

year

2022

volume

41

issue

5

pages

599-607

Sources and links

• Publisher record via DOI (primary)
• PubMed 35351385

Related

Links from this record

• tests: ISHLT 2019 CLAD states: Potential, Possible, Probable and Definite
• classifies: Bronchiolitis obliterans syndrome (BOS)
• classifies: Restrictive allograft syndrome (RAS)
• classifies: Undefined phenotype
• supports: Chest CT: parenchymal patterns and density in CLAD
• authors affiliated with: Toronto Lung Transplant Program (University Health Network)
• coauthor: Lianne Singer
• coauthor: Tereza Martinu

Linked from (derived)

• author: Lianne Singer
• author: Tereza Martinu
• evidence: Clinical CLAD phenotypes are hard to assign reproducibly

Known gaps in this record

• full text not read (abstract only)
• funding statement and grant numbers
• centre named in abstract