CLAD is recognised late and no biomarker is validated for early warning
Evidence level: proposed bottleneck; synthesis of abstract-level sources; pending approval
CLAD is defined by persistent lung function decline, and none of the many proposed blood, lavage or tissue biomarkers is universally accepted in practice.
As of . Primary source: Review: novel biomarkers of CLAD (DOI).
Summary
A 2022 review states that none of the potential biomarkers from lavage, biopsy and serum is universally accepted or implemented, that only a very limited number has reached routine clinical practice, and that progress has been made for donor-derived cell-free DNA and donor-specific antibodies. The GEO record for a whole blood study states that CLAD is diagnosed late on the decline in lung function, when immune intervention is ineffective. A 2024 pilot of donor-derived cell-free DNA in 20 CLAD patients found elevated levels in only 47 percent of stable samples and 71 percent of CLAD samples, with high intra- and interpatient variability. A 2026 validation study did not confirm the earlier lavage CCSP threshold on its own, though the association held in combined cohorts. The statement that diagnosis is late is the source authors' framing, not a measured delay.
Details
- barrier type
- diagnostics and biomarkers
Sources and links
Related
Links from this record
- evidence: Novel biomarkers of chronic lung allograft dysfunction: is there anything reliable?
- evidence: Donor-derived cell-free DNA in chronic lung allograft dysfunction phenotypes: a pilot study
- evidence: Reduced lung fluid club cell secretory protein informs chronic lung allograft dysfunction risk
- evidence: GEO GSE94557: whole blood gene expression in lung recipients with CLAD
- affects: Donor-derived cell-free DNA
- affects: Epithelial injury markers
- affects: Autoantibodies
- affects: Airway transcriptomic signatures
- affects: Microbiome-derived signals
- affects: Spirometry: FEV1 decline from baseline in the ISHLT 2019 CLAD definition
- tests: Plasma and Radiologic Biomarkers of Response to ECP in Lung Transplant Recipients With CLAD
Known gaps in this record
- time between first physiological change and CLAD diagnosis (not measured in the sources opened)
- head-to-head performance of biomarkers (not available from abstracts)
Information resource only. Not medical advice. Not a substitute for the care of the patient's transplant team.