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Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single‐center study
Author(s) -
Verleden Stijn E.,
Von Der Thüsen Jan,
Van Herck Anke,
Weynand Birgit,
Verbeken Erik,
Verschakelen Johny,
Dubbeldam Adriana,
Vanaudenaerde Bart M.,
Vos Robin,
Verleden Geert M.
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13781
Subject(s) - medicine , bronchiolitis obliterans , single center , phenotype , lung transplantation , pathology , pulmonary function testing , histopathology , lung , gastroenterology , biochemistry , chemistry , gene
Rationale Patients can change chronic lung allograft dysfunction (CLAD) phenotype, especially from BOS to mixed phenotype. Our aim was to further characterize these patients. Method Mixed CLAD was defined as a restrictive physiology with persistent CT opacities, after initial bronchiolitis obliterans syndrome (BOS) diagnosis. The incidence, prognosis, pulmonary function, radiology, pathology, and airway inflammation were compared between patients with restrictive allograft syndrome (RAS) and mixed CLAD. Result A total of 268 (44%) patients developed CLAD of which 47 (18%) were diagnosed with RAS “ab initio,” 215 (80%) with BOS, and 6 (2%) an undefined phenotype. Twenty‐five patients developed a mixed CLAD phenotype (24 BOS to mixed and 1 RAS to mixed). Survival after mixed phenotype diagnosis was comparable ( P = .39) to RAS. More emphysema patients developed a mixed phenotype ( P = .020) compared to RAS ab initio, while mixed CLAD patients had a lower FEV 1 ( P < .0001) and FEV 1 /FVC ( P = .0002) at diagnosis compared to RAS ab initio. CT scans in patients with the mixed phenotype demonstrated apical predominance of the opacities ( P = .0034) with pleuroparenchymal fibroelastosis on histopathology. Conclusion We further characterized patients with a mixed phenotype of CLAD. Although the survival after diagnosis was comparable to RAS ab initio patients, there was a difference in demography, pulmonary function, radiology, and pathology.