Topic
Lung transplantation
Allocation, donor selection, and chronic allograft dysfunction.
What the evidence shows
Tacrolimus beats ciclosporin on the outcome that actually limits survival: once-daily tacrolimus significantly reduced three-year chronic lung allograft dysfunction (ScanCLAD).
Surveillance biopsy creates its own dilemma — what to do about rejection nobody would have found without looking. A first, stable, subclinical grade A1 episode left untreated did not increase allograft loss or death, so watchful waiting is defensible (Levy 2020).
How the graft is monitored may be due for revision. Modelling nearly 60,000 FEV1 measurements identified distinct decline trajectories associated with different outcomes, suggesting a more granular classification than the current threshold-based definition (FEV1 trajectories).
Immunosuppression after lung transplant
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| ScanCLAD | 2024 | Once-daily tacrolimus | Once-daily tacrolimus reduced chronic lung allograft dysfunction versus ciclosporin |
Monitoring the allograft
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| FEV1 trajectories cohort study | 2025 | FEV1 trajectory modelling | Distinct patterns of FEV1 decline after transplant predicted different outcomes |
Treating minimal rejection
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| Levy 2020 retrospective cohort | 2020 | Watchful waiting for minimal acute rejection | Leaving a first episode of minimal subclinical rejection untreated did not increase allograft loss or death |
Key references
Guidelines, standards and reviews for this topic.
- Acute and Chronic Graft Rejection
- Kotecha S, Ivulich S, Snell G. Review: immunosuppression for the lung transplant patient. J Thorac Dis 2021 Nov;13(11):6628-6644. PMID 34992841
- 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 May;38(5):493-503. PMID 30962148
- Glanville AR, Verleden GM, Todd JL, et al. Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant 2019 May;38(5):483-492. PMID 31027539
- Tikkanen JM, Singer LG, Kim SJ, et al. De Novo DQ Donor-Specific Antibodies Are Associated with Chronic Lung Allograft Dysfunction after Lung Transplantation. Am J Respir Crit Care Med 2016 Sep 1;194(5):596-606. PMID 26967790
- Annual ISHLT Registry Reports
- Perch M, Hayes D Jr, Cherikh WS, et al. International experience of donation after circulatory death for lung transplantation. A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2025 Sep;44(9):1375-1383. PMID 40306562
- Overview
- Christie JD, Van Raemdonck D, Fisher AJ. Lung Transplantation. N Engl J Med 2024 Nov 14;391(19):1822-1836. PMID 39536228
- Post Transplant Management Reviews
- Adegunsoye A, Strek ME, Garrity E, et al. Comprehensive Care of the Lung Transplant Patient. Chest 2017 Jul;152(1):150-164. PMID 27729262
- Mahajan AK, Folch E, Khandhar SJ, et al. The Diagnosis and Management of Airway Complications Following Lung Transplantation. Chest 2017 Sep;152(3):627-638. PMID 28274791
- Hathorn KE, Chan WW, Lo WK. Role of gastroesophageal reflux disease in lung transplantation. World J Transplant 2017 Apr 24;7(2):103-116. PMID 28507913
- Recipient Selection
- Florissi I, Chidi AP, Liu Y, et al. Racial Disparities in Waiting List Outcomes of Patients Listed for Lung Transplantation. Ann Thorac Surg 2024 Mar;117(3):619-626. PMID 37673311
- Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021 Nov;40(11):1349-1379. PMID 34419372