No therapy of proven benefit for established CLAD
Evidence level: proposed bottleneck; synthesis of abstract-level sources; pending approval
No treatment has shown clear benefit for established CLAD in randomised trials, and guideline authors call for high-quality trials.
As of . Primary source: ESOT clinical practice guideline (DOI).
Summary
Several sources opened for this record agree on an evidence gap. The 2026 ESOT guideline (GRADE methodology) found current data inconclusive for anti-thymocyte globulin, alemtuzumab and extracorporeal photopheresis against standard care, did not support antifibrotics in BOS, and emphasised the urgent need for high-quality trials. A 90-patient European phase II trial of pirfenidone in progressive BOS found no difference in FEV1 change from placebo. A 2023 review of lymphocyte-depleting therapies states that interpretation of most results is hampered by the lack of randomised controlled trials. A 2026 early economic model states there was very little quality evidence to inform it. A survey of 44 European centres found no single treatment strategy universally used. The word proven is used here only to mean shown in randomised trials as reported in these abstracts.
Details
- barrier type
- therapeutic evidence
Sources and links
Related
Links from this record
- evidence: European society for organ transplantation clinical practice guideline on prevention and treatment of chronic lung allograft dysfunction
- evidence: A European multicentre, randomised controlled trial of pirfenidone in bronchiolitis obliterans syndrome after bilateral lung transplantation
- evidence: Lymphocyte Depleting and Modulating Therapies for Chronic Lung Allograft Dysfunction
- evidence: Early Economic Model of Extracorporeal Photopheresis and Other Treatments of Chronic Lung Allograft Dysfunction After Lung Transplantation
- evidence: Chronic lung allograft dysfunction after lung transplantation: prevention, diagnosis and treatment in 44 European centres
- affects: Extracorporeal photopheresis (ECP)
- affects: Azithromycin
- affects: Belumosudil
- tests: A Study to Test How Effective Belumosudil Tablets Are for Treating Adult Participants With Chronic Lung Allograft Dysfunction
- tests: Belumosudil to Block Chronic Lung Allograft Dysfunction (CLAD) in High Risk Lung Transplant Recipients
- tests: Extracorporeal Photopheresis for Medicare Recipients of Lung Allografts
- affects: Bronchiolitis obliterans syndrome (BOS)
- affects: Restrictive allograft syndrome (RAS)
Known gaps in this record
- results of the registered phase 3 and phase 2 trials linked here (not read)
- strength and certainty rating of each ESOT recommendation (full text not read)
- any therapy specific to RAS (the sources opened do not report one)
Information resource only. Not medical advice. Not a substitute for the care of the patient's transplant team.