Non-Bronchiolitis Obliterans Syndrome Forms of Chronic Lung Allograft Dysfunction
The bronchiolitis obliterans syndrome (BOS) has been described as the clinical correlate of chronic lung allograft rejection and defined as irreversible airflow obstruction in the absence of other causes. However, it has become apparent that BOS does not explain all chronic lung allograft dysfunction (CLAD) and that a variety of other etiologies with a mixed obstructive and restrictive pattern on spirometry, or even a pure restrictive picture (restrictive allograft syndrome, or RAS), are also identifiable. Surgical, mechanical, vascular obstructive, infectious, and infiltrative processes, as well as a whole range of chronic lung allograft rejection entities need to be considered in making a diagnosis of CLAD. The performance of any lung allograft is really the sum-of-the-parts of all of these processes, and considering non-BOS CLAD in all its forms may potentially provide more therapeutic options than just considering BOS alone as the explanation for declining lung function.
KeywordsLung transplantation Bronchiolitis obliterans syndrome Chronic lung allograft dysfunction Obliterative bronchiolitis Restrictive lung allograft syndrome Allograft rejection Chronic rejection
Support for this work comes from the Margaret Pratt Foundation.
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