Global approaches to chronic lung allograft dysfunction: Toward evidence-based harmonization

Summary

This single-author review states that international surveys show practice harmonisation alongside persistent geographic variation. Diagnostic work-up has converged (spirometry, chest CT, bronchoscopy with lavage and biopsy, donor-specific antibody testing) but more standardisation is needed for pulmonary function reporting, imaging protocols and pathology workflows. Therapy is more heterogeneous, with major differences in azithromycin prophylaxis, reflux management, corticosteroid pulses, lymphocyte-depleting agents, extracorporeal photopheresis, montelukast and bronchodilators. The author argues that such variation identifies priorities where comparative evidence is lacking, and calls for standardised treatment algorithms, biomarker-guided interventions and pragmatic trials.

Details

doi

10.1016/j.healun.2026.07.029

pmid

42521131

authors

Vos R

journal

The Journal of Heart and Lung Transplantation

year

2026

Sources and links

• Publisher record via DOI (primary)
• PubMed 42521131

Related

Links from this record

• discusses: Azithromycin
• discusses: Extracorporeal photopheresis (ECP)
• discusses: HLA donor-specific antibody and non-HLA antibody testing
• discusses: Chest CT: parenchymal patterns and density in CLAD
• authors affiliated with: KU Leuven BREATHE (Laboratory of Respiratory Diseases and Thoracic Surgery)
• coauthor: Robin Vos

Linked from (derived)

• author: Robin Vos
• evidence: CLAD care and measurement vary between centres

Known gaps in this record

• full text not read (abstract only)
• funding statement and grant numbers
• full text and cited surveys (not read)
• funding and conflicts of interest