Diagnostic evaluation of potential chronic lung allograft syndrome

Diagnosis and evaluation of CLAD based on spirometry, lung volumes, and CT findings. Baseline refers to the post-transplant baseline spirometry and lung volumes; for FEV₁ this is defined as the average of the two maximal post-transplant FEV₁ values (performed at least three weeks apart). The TLC baseline should be the post-transplant TLC associated with baseline FEV₁. Please refer to UpToDate content on CLAD for additional information.

BAL: bronchoalveolar lavage; BOS: bronchiolitis obliterans syndrome; CLAD: chronic lung allograft dysfunction; CT: computed tomography; FEV₁: forced expiratory volume in one second; FVC: forced vital capacity; ISHLT: International Society for Heart and Lung Transplantation; RAS: restrictive allograft syndrome; TLC: total lung capacity.

* For patients with severe obstruction or frailty, the benefits of transbronchial biopsy may not be worth the risks. Please refer to UpToDate content on CLAD-BOS for further information.

¶ For the purposes of CLAD phenotyping, CT findings of concern are persistent (lasting greater than three months) reticulations, ground-glass opacities, or consolidations consistent with possible fibrosis. New persistent pleural thickening is also a qualifying feature. For patients with BOS, no specific findings are required for phenotyping, but characteristic findings include bronchiectasis, bronchiolitis, and mosaicism consistent with air trapping.

References:

Verleden GM, Glanville AR, Lease ED, et al. Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment—A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant 2019; 38:493.
Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: Validation and proposed refinement of the 2019 International Society for Heart and Lung Transplantation classification system. J Heart Lung Transplant 2020; 39:761.

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Diagnostic evaluation of potential chronic lung allograft syndrome