Evidence map›Paper›PMID 40470157›Full record

ArticleERJ open research2025

Chronic lung allograft dysfunction after lung transplantation: prevention, diagnosis and treatment in 44 European centres.

Jens Gottlieb, Robin Vos, Peter Jaksch, Merel Hellemons, Are Martin Holm, Letizia Corinna Morlacchi, Jesper Magnusson, Rodrigo Alonso Moralejo, Víctor M Mora-Cuesta, Vera Ennekes and 30 more

Abstract read
In one paragraph

Article in ERJ open research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Guideline
  2. European society for organ transplantation clinical practice guideline on prevention and treatment of chronic lung allograft dysfunction.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Guideline
  3. Approach to prevention and management of chronic lung allograft dysfunction in North American lung transplant centers.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
    Article
  4. Article
  5. Article
  6. Article
  7. Post-lung transplant surveillance in 2026: current practice, variability, and the need for standardization.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Review
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

40 authors.

Jens GottliebDepartment of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany.ORCID https://orcid.org/0000-0002-9540-9022
Robin VosEuropean Reference Network of Rare Lung Diseases (ERN-LUNG), Frankfurt, Germany.ORCID https://orcid.org/0000-0002-3468-9251
Peter JakschEuropean Reference Network of Rare Lung Diseases (ERN-LUNG), Frankfurt, Germany.ORCID https://orcid.org/0000-0003-4635-3242
Merel HellemonsDepartment of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.ORCID https://orcid.org/0000-0002-6666-5027
Are Martin HolmOslo University Hospital, Oslo, Norway.
Letizia Corinna MorlacchiRespiratory Unit and Cystic Fibrosis Center, Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milan, Italy.ORCID https://orcid.org/0000-0002-4661-6471
Jesper MagnussonDepartment of Pulmonary Medicine, Institute of Internal Medicine, University of Gothenburg, Gothenburg, Sweden.ORCID https://orcid.org/0000-0002-5630-0155
Rodrigo Alonso MoralejoHospital Universitario 12 de Octubre, Madrid, Spain.
Víctor M Mora-CuestaEuropean Reference Network of Rare Lung Diseases (ERN-LUNG), Frankfurt, Germany.ORCID https://orcid.org/0000-0002-8161-0462
Vera EnnekesDepartment of Pulmonary Medicine, University Medicine Essen - Ruhrlandklinik, Essen, Germany.
Anna ReedHarefield Hospital and Imperial College, London, UK.
Claire Merveilleux Du VignauxHospices Civils de Lyon, Centre de Transplantation Pulmonaire et Cardiopulmonaire, Louis Pradel Hospital, Lyon, France.
Ina HettichDepartment of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
David BennettRespiratory Diseases Unit, University Hospital of Siena, Siena, Italy.
Matthias HeckerGerman Center for Lung Research (DZL), Giessen, Germany.
Alexandra WaldUniversity Hospital Leipzig, Leipzig, Germany.
Svitlana GukRespiratory Medicine and Allergology Center, Feofania Hospital, Kyiv, Ukraine.
Andris SkridePauls Stradins Clinical University Hospital, Riga Stradiņš University, Riga, Latvia.
Anna NoldeUniversity Hospital Hamburg Eppendorf, Hamburg, Germany.
Christiane KnoopDepartment of Chest Medicine, Hôpital Universitaire de Bruxelles, Brussels, Belgium.
Federica MeloniEuropean Reference Network of Rare Lung Diseases (ERN-LUNG), Frankfurt, Germany.ORCID https://orcid.org/0000-0003-4014-0617
Jussi TikkanenHelsinki University Hospital, Helsinki, Finland.
Hillevi LarssonSkåne University Hospital, Lund, Sweden.
Adrien TissotNantes Université, CHU Nantes, INSERM, Service de Pneumologie, L'institut du Thorax, Nantes, France.ORCID https://orcid.org/0000-0002-3259-6430
Peter RiddellMater University Hospital, Dublin, Ireland.ORCID https://orcid.org/0000-0002-3513-512X
Jérôme Le PavecHôpital Marie Lannelongue, Le Plessis-Robinson, France.
Michael PerchDepartment of Cardiology, Section for Lung Transplantation, Heartcentre, Rigshospitalet, Copenhagen, Denmark.ORCID https://orcid.org/0000-0001-9740-1246
Benjamin Renaud-PicardStrasbourg Lung Transplant Program, Université de Strasbourg, Strasbourg, France.ORCID https://orcid.org/0000-0003-3492-9486
François M CarlierLung Transplant Center, CHU UCL Namur, Namur, Belgium.ORCID https://orcid.org/0000-0001-6205-0087
Veronika MüllerEuropean Reference Network of Rare Lung Diseases (ERN-LUNG), Frankfurt, Germany.ORCID https://orcid.org/0000-0002-1398-3187
Jasvir ParmarRoyal Papworth Hospital, Respiratory Medicine, Cambridge, UK.
Jan HavlinPrague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic.
Rosalía LaportaHospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Spain.
Macé Matthew SchuurmansZürich Lung Transplant Program, Zurich, Switzerland.ORCID https://orcid.org/0000-0001-5404-7566
Matevž HarlanderUniversity Medical Centre Ljubljana, Ljubljana, Slovenia.
Slavomir ZenglenKlinika Alergologii i Pneumonologii, Gdański Uniwersytet Medyczny, Gdansk, Poland.
Olivier BrugiereDepartment of Pneumology and Lung Transplantation, Foch Hospital, Suresne, France.ORCID https://orcid.org/0000-0002-3500-5253
Nikolaus KneidingerGerman Center for Lung Research (DZL), Giessen, Germany.ORCID https://orcid.org/0000-0001-7583-0453
Andrew FisherInstitute of Transplantation, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Berta Saez-GimenezEuropean Reference Network of Rare Lung Diseases (ERN-LUNG), Frankfurt, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: There are limited data on optimal management of chronic lung allograft dysfunction (CLAD). We aimed to describe the variability of diagnostic and therapeutic practices in Europe. Methods: A structured questionnaire was sent to 71 centres in 24 countries. Questions were related to contemporary clinical practices for workup, monitoring and treatment of CLAD. The number of lung transplant procedures and patients in follow-up were collected. Results: 44 centres (62%) responded from 20 countries, representing 74% of European activity. The prevalence of CLAD was estimated at 9.1 cases per million population (25th and 75th percentiles of 4.4, 15.7). Preferred initial workup for probable CLAD consisted of chest computed tomography (CT) (inspiratory 91% and expiratory 74%), donor-specific antibody (DSA) measurement (86%), bronchoalveolar lavage (BAL) (85%) and transbronchial biopsy (81%). For monitoring of definite CLAD, inspiratory CT (67%), DSA (61%) and BAL (43%) were preferred. Body plethysmography was unavailable for 16% of cases. Prophylaxis was based on preventing infections (cytomegalovirus 99%, inhaled antibiotics 70% and antifungals 65%), tacrolimus-based immunosuppression (96%), azithromycin (72%) and universal proton pump inhibitor treatment (84%). First-line treatment of CLAD was based on azithromycin (82%) and steroid augmentation (74%). Photopheresis was used in 26% of cases. Conclusion: Current European practice CLAD detection is based on spirometry, inspiratory CT and DSA, with limited access to plethysmography and expiratory CT. Prophylactic treatment is based on azithromycin, tacrolimus-based immunosuppression and treatment of risk factors. No single treatment strategy is universally used, highlighting the need for an effective treatment of CLAD. The preferred first-line strategy is azithromycin and steroid augmentation.

Identifiers

PMID40470157
PMCPMC12134928

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