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Chronic lung allograft dysfunction — SCE Respiratory MCQ

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HardRare and miscellaneousChronic lung allograft dysfunctionSCE Respiratory

A bilateral lung recipient has a sustained FEV1 of 76% of the post-transplant reference value for 5 weeks. Infection, acute rejection, anastomotic stenosis and pleural disease are excluded; CT shows air trapping without persistent restriction. What phenotype is present?

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Correct answer: E — Obstructive CLAD with a bronchiolitis obliterans syndrome phenotype

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

D is correct. Persistent FEV1 decline at least 20% from the reference after excluding reversible causes meets CLAD; obstructive physiology and air trapping without restrictive opacities support BOS. RAS requires restrictive physiology and persistent pleuroparenchymal opacities. Acute rejection is an exclusion rather than the label here. Primary graft dysfunction occurs immediately after transplant, and donor emphysema does not explain the consensus CLAD trajectory.

Reference: ISHLT consensus on chronic lung allograft dysfunction: https://www.jhltonline.org/article/S1053-2498(18)31635-5/fulltext