FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3036860913> ?p ?o ?g. }

• W3036860913 endingPage "773" @default.
• W3036860913 startingPage "771" @default.
• W3036860913 abstract "See Related Article, page 761 See Related Article, page 761 Since the inception of lung transplantation, serial pulmonary function testing has been key to quantifying allograft health. In 1993, an International Society for Heart and Lung Transplantation consensus report standardized the approach to using pulmonary function test measures to benchmark lung allograft function.1Cooper JD Billingham M Egan T et al.A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts.International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 1993; 12: 713-716PubMed Google Scholar Specifically, chronic graft dysfunction or bronchiolitis obliterans syndrome (BOS) was suggested by a sustained ≥20% decline in forced expiratory volume in 1 second (FEV1) as compared with the average of the 2 best post-transplant FEV1s measured at least 3 weeks apart in the absence of evident confounders.1Cooper JD Billingham M Egan T et al.A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts.International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 1993; 12: 713-716PubMed Google Scholar The simple elegance of this construct and its later revision in 20022Estenne M Maurer JR Boehler A et al.Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria.J Heart Lung Transplant. 2002; 21: 297-310Abstract Full Text Full Text PDF PubMed Scopus (1112) Google Scholar proved highly useful to characterize functional results in lung recipients. Yet with growing lung transplant experience, it became apparent that some patients develop persistent graft dysfunction with clinical manifestations not in keeping with BOS.3Pakhale SS Hadjiliadis D Howell DN et al.Upper lobe fibrosis: a novel manifestation of chronic allograft dysfunction in lung transplantation.J Heart Lung Transplant. 2005; 24: 1260-1268Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar The last decade has realized tremendous progress in the development of systematic approaches to identify patients with features of chronic graft dysfunction atypical for BOS, particularly those presenting with predominant restrictive physiology and radiographic opacities—termed restrictive allograft syndrome (RAS). These studies have consistently demonstrated that RAS carries a worse survival after diagnosis than BOS.4Sato M Waddell TK Wagnetz U et al.Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction.J Heart Lung Transplant. 2011; 30: 735-742Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar, 5Verleden GM Vos R Verleden SE et al.Survival determinants in lung transplant patients with chronic allograft dysfunction.Transplantation. 2011; 92: 703-708Crossref PubMed Scopus (85) Google Scholar, 6Todd JL Jain R Pavlisko EN et al.Impact of forced vital capacity loss on survival after the onset of chronic lung allograft dysfunction.Am J Respir Crit Care Med. 2014; 189: 159-166Crossref PubMed Scopus (58) Google Scholar, 7DerHovanessian A Todd JL Zhang A et al.Validation and refinement of chronic lung allograft dysfunction phenotypes in bilateral and single lung recipients.Ann Am Thorac Soc. 2016; 13: 627-635Crossref PubMed Scopus (31) Google Scholar, 8Kneidinger N Milger K Janitza S et al.Lung volumes predict survival in patients with chronic lung allograft dysfunction.Eur Respir J. 2017; 491601315Crossref PubMed Scopus (22) Google Scholar, 9Suhling H Dettmer S Greer M et al.Phenotyping chronic lung allograft dysfunction using body plethysmography and computed tomography.Am J Transplant. 2016; 16: 3163-3170Crossref PubMed Scopus (34) Google Scholar The term chronic lung allograft dysfunction (CLAD) was introduced in 2010 in an effort to encompass the variable manifestations of irreversible allograft decline10Glanville AR Bronchoscopic monitoring after lung transplantation.Semin Respir Crit Care Med. 2010; 31: 208-221Crossref PubMed Scopus (54) Google Scholar; however, for years it lacked a clear definition. To address this gap, a taskforce of the International Society for Heart and Lung Transplantation Pulmonary Council put forth the first CLAD consensus criteria in 2019.11Verleden GM Glanville AR Lease ED et al.Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-a consensus report from the Pulmonary Council of the ISHLT.J Heart Lung Transplant. 2019; 38: 493-503Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar The consensus statement provided a definition for CLAD (identified as a sustained ≥20% FEV1 decline akin to the prior BOS working definition) and incorporated new knowledge regarding differentiating CLAD to the phenotypes of BOS or RAS based on physiologic and radiographic parameters. Additionally, the consensus document laid a framework for a mixed CLAD phenotype with both obstructive and restrictive physiology in addition to radiographic opacities and an undefined CLAD phenotype in which obstructive physiology manifests along with radiographic opacities or in which features of both obstruction and restriction manifest in the absence of radiographic opacities.11Verleden GM Glanville AR Lease ED et al.Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-a consensus report from the Pulmonary Council of the ISHLT.J Heart Lung Transplant. 2019; 38: 493-503Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar In a notable divergence from the original BOS consensus and the investigations that followed, including those distinguishing BOS from RAS, the CLAD consensus modified the definition of BOS to include not only a ≥20% FEV1 decline but also the presence of physiologic obstruction identified by an FEV1/forced vital capacity (FVC) ratio of <0.7. In this issue of the journal, Levy et al.12Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: validation and proposed refinement of the 2019 ISHLT classification system [e-pub ahead of print]. J Heart Lung Transplant. doi: 10.1016/j.healun.2020.04.012, accessed June 26, 2020.Google Scholar applied the 2019 CLAD consensus definitions in a single-center cohort of over 500 bilateral lung recipients to understand the distribution of CLAD across the phenotypes of BOS, RAS, mixed, or undefined and examine survival after CLAD in these subsets. A striking finding of the study is that 15% of patients with CLAD were not able to be assigned to a CLAD phenotype. In fact, patients with CLAD remaining phenotypically unclassified represented a larger percentage of patients than those in either of the RAS, mixed, or undefined groups. Moreover, the unclassified and undefined groups together accounted for 25% of patients with CLAD. In contrast to prior work suggesting that approximately one third of patients with CLAD manifest as RAS phenotype,4Sato M Waddell TK Wagnetz U et al.Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction.J Heart Lung Transplant. 2011; 30: 735-742Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar only 9% of CLAD patients were assigned to RAS in this study. Survival after onset of RAS and mixed phenotypes of CLAD was worse than that for BOS, in keeping with previous studies,4Sato M Waddell TK Wagnetz U et al.Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction.J Heart Lung Transplant. 2011; 30: 735-742Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar,5Verleden GM Vos R Verleden SE et al.Survival determinants in lung transplant patients with chronic allograft dysfunction.Transplantation. 2011; 92: 703-708Crossref PubMed Scopus (85) Google Scholar whereas patients in the undefined and unclassified groups had post-CLAD survival similar to BOS. Also consistent with prior work,7DerHovanessian A Todd JL Zhang A et al.Validation and refinement of chronic lung allograft dysfunction phenotypes in bilateral and single lung recipients.Ann Am Thorac Soc. 2016; 13: 627-635Crossref PubMed Scopus (31) Google Scholar,9Suhling H Dettmer S Greer M et al.Phenotyping chronic lung allograft dysfunction using body plethysmography and computed tomography.Am J Transplant. 2016; 16: 3163-3170Crossref PubMed Scopus (34) Google Scholar the authors demonstrated that the presence of radiographic RAS-like opacities conferred worse prognosis after CLAD. This was true when considering all patients with CLAD, irrespective of physiologic phenotype, and when evaluated only among those in the undefined and unclassified subsets. The study by Levy et al.12Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: validation and proposed refinement of the 2019 ISHLT classification system [e-pub ahead of print]. J Heart Lung Transplant. doi: 10.1016/j.healun.2020.04.012, accessed June 26, 2020.Google Scholar is important as it is the first to put the 2019 CLAD consensus definitions to the test and, as such, illuminates several important considerations. First, it is notable that only bilateral lung recipients were included. Thus, the applicability of the CLAD definitions to single lung recipients has not been well substantiated, neither in studies on which the criteria were based nor in the evaluation by Levy et al.12Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: validation and proposed refinement of the 2019 ISHLT classification system [e-pub ahead of print]. J Heart Lung Transplant. doi: 10.1016/j.healun.2020.04.012, accessed June 26, 2020.Google Scholar Next, and quite intriguingly, majority of the patients with CLAD unable to be phenotypically classified had neither obstruction (identified by FEV1/FVC < 0.7), restriction, nor radiographic opacities. Moreover, these patients demonstrated survival after CLAD onset similar to those with BOS phenotype. It is highly plausible this group is composed of patients with stage 1 CLAD in whom FEV1 values are preserved closer to 80% of the post-transplant best. Thus, these patients with features otherwise consistent with BOS may have insufficient FEV1 decline to result in a diminished FEV1/FVC ratio. This will be an important point to clarify moving forward, as at least 1 clinical trial actively enrolling CLAD subjects with BOS phenotype specifies inclusion criteria of FEV1 between 60% and 85% of personal best (approximating stage 1 CLAD) and an FEV1/FVC ratio ≤ 0.7.13U.S. National Library of Medicine. A clinical trial to demonstrate the effectiveness and safety of liposomal cyclosporine A inhalation solution in the treatment of bronchiolitis obliterans syndrome in patients post double lung transplant (BOSTON-2). Available at:https://clinicaltrials.gov/ct2/show/NCT03656926?cond=inhaled+cyclosporine&draw=2&rank=8.Google Scholar It is unclear how many patients with stage 1 CLAD and otherwise features of BOS may be ineligible for such studies on the basis of the FEV1/FVC remaining > 0.7. How this important nuance may impact trial enrollment and the overall success of evaluating BOS therapies is uncertain. Incorporating the FEV1/FVC ratio into the diagnostic criteria for BOS phenotype, although founded in the principles of physiology, may have unintended consequences when applied within the broader CLAD construct. Another point brought to light in the Levy study12Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: validation and proposed refinement of the 2019 ISHLT classification system [e-pub ahead of print]. J Heart Lung Transplant. doi: 10.1016/j.healun.2020.04.012, accessed June 26, 2020.Google Scholar is the difficulty in conducting statistically sound analyses examining survival after CLAD and its phenotypes when CLAD phenotype is not assigned on the CLAD onset date. The 2019 consensus document specifies that CLAD onset occurs at the time of the first measurement demonstrating FEV1 decline ≥20% from baseline, yet recommends that the definite CLAD phenotype be assigned on the basis of spirometric indices, lung volumes, and radiographic findings 3 or more months after CLAD onset. In keeping with their study objectives, the authors applied this methodology—using physiologic data up to 3 months and radiographic data up to 6 months after CLAD onset to make phenotype assignments. Despite the delay of as many as 6 months from CLAD onset to phenotype assignment, the authors used the CLAD onset date in their analyses examining survival after the onset of each phenotype. As the information being used to assign risk in these analyses was not necessarily present at CLAD onset, the statistical validity of this approach is called into question. This highlights the challenge of creating consensus disease definitions that are relevant and able to be meaningfully employed in both the clinical and research arenas. Although perhaps useful from a clinical care standpoint, from a research perspective, separating the timing of CLAD onset from definite phenotype assignment is problematic, creating a potential source of bias in survival analyses in particular. The development of the 2019 CLAD consensus statement represents a major advance for the lung transplant community, incorporating nearly 2 decades of scientific knowledge generated since the last BOS consensus revisions to create a common nomenclature for CLAD and integrate CLAD phenotype determination into the diagnostic paradigm.11Verleden GM Glanville AR Lease ED et al.Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-a consensus report from the Pulmonary Council of the ISHLT.J Heart Lung Transplant. 2019; 38: 493-503Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar Yet, a diagnostic algorithm that leaves a substantive proportion of patients unclassified or undefined, if this finding is replicated in other studies, makes it clear that the community must take a step back and consider what refinements will be necessary in future iterations of the CLAD consensus. In particular, a discussion provoked by both this study and prior work7DerHovanessian A Todd JL Zhang A et al.Validation and refinement of chronic lung allograft dysfunction phenotypes in bilateral and single lung recipients.Ann Am Thorac Soc. 2016; 13: 627-635Crossref PubMed Scopus (31) Google Scholar,9Suhling H Dettmer S Greer M et al.Phenotyping chronic lung allograft dysfunction using body plethysmography and computed tomography.Am J Transplant. 2016; 16: 3163-3170Crossref PubMed Scopus (34) Google Scholar,12Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: validation and proposed refinement of the 2019 ISHLT classification system [e-pub ahead of print]. J Heart Lung Transplant. doi: 10.1016/j.healun.2020.04.012, accessed June 26, 2020.Google Scholar is whether patients with CLAD can be distinguished to clinically relevant phenotypes on the basis of radiographic findings alone without regard to physiologic manifestations. Whether such phenotypic categorization would also identify patients with distinct pathobiology, thus perhaps compelling different therapeutic approaches, requires further investigation. The work by Levy et al.12Levy L, Huszti E, Renaud-Picard B, et al. Risk assessment of chronic lung allograft dysfunction phenotypes: validation and proposed refinement of the 2019 ISHLT classification system [e-pub ahead of print]. J Heart Lung Transplant. doi: 10.1016/j.healun.2020.04.012, accessed June 26, 2020.Google Scholar suggests that there is ample opportunity to enhance the current approach to CLAD phenotyping. Winston Churchill is reported to have said, “The pessimist sees difficulty in every opportunity. The optimist sees opportunity in every difficulty.” Optimism abounds that the immense difficulty of establishing meaningful approaches to CLAD classification will create significant opportunities to improve and personalize lung recipient care. Dr Todd has no related conflicts of interest to disclose. He has received grants to the institution from Boehringer Ingelheim unrelated to the current work and has additional funding from the National Institutes of Health award number K23AI125670 unrelated to the current work. Risk assessment of chronic lung allograft dysfunction phenotypes: Validation and proposed refinement of the 2019 International Society for Heart and Lung Transplantation classification systemThe Journal of Heart and Lung TransplantationVol. 39Issue 8PreviewChronic lung allograft dysfunction (CLAD) is a heterogeneous condition. Characterization of CLAD phenotypes is essential to enhance the understanding of pathogenesis and guide new therapies. The study objective was to validate the new International Society for Heart and Lung Transplantation (ISHLT) CLAD classification system and further explore patients who do not fall into the defined CLAD sub-categories. Full-Text PDF" @default.
• W3036860913 created "2020-06-25" @default.
• W3036860913 creator A5043961879 @default.
• W3036860913 date "2020-08-01" @default.
• W3036860913 modified "2023-09-26" @default.
• W3036860913 title "Putting the 2019 CLAD consensus definitions to the test: Two steps forward, one step back?" @default.
• W3036860913 cites W1847284976 @default.
• W3036860913 cites W2019747621 @default.
• W3036860913 cites W2102601462 @default.
• W3036860913 cites W2132227824 @default.
• W3036860913 cites W2164089177 @default.
• W3036860913 cites W2324538748 @default.
• W3036860913 cites W2346137162 @default.
• W3036860913 cites W2403838786 @default.
• W3036860913 cites W2607396025 @default.
• W3036860913 cites W2933321059 @default.
• W3036860913 cites W3024562920 @default.
• W3036860913 doi "https://doi.org/10.1016/j.healun.2020.06.008" @default.
• W3036860913 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/32620449" @default.
• W3036860913 hasPublicationYear "2020" @default.
• W3036860913 type Work @default.
• W3036860913 sameAs 3036860913 @default.
• W3036860913 citedByCount "3" @default.
• W3036860913 countsByYear W30368609132022 @default.
• W3036860913 countsByYear W30368609132023 @default.
• W3036860913 crossrefType "journal-article" @default.
• W3036860913 hasAuthorship W3036860913A5043961879 @default.
• W3036860913 hasBestOaLocation W30368609131 @default.
• W3036860913 hasConcept C151730666 @default.
• W3036860913 hasConcept C19527891 @default.
• W3036860913 hasConcept C2777267654 @default.
• W3036860913 hasConcept C71924100 @default.
• W3036860913 hasConcept C86803240 @default.
• W3036860913 hasConceptScore W3036860913C151730666 @default.
• W3036860913 hasConceptScore W3036860913C19527891 @default.
• W3036860913 hasConceptScore W3036860913C2777267654 @default.
• W3036860913 hasConceptScore W3036860913C71924100 @default.
• W3036860913 hasConceptScore W3036860913C86803240 @default.
• W3036860913 hasIssue "8" @default.
• W3036860913 hasLocation W30368609131 @default.
• W3036860913 hasOpenAccess W3036860913 @default.
• W3036860913 hasPrimaryLocation W30368609131 @default.
• W3036860913 hasRelatedWork W1986554448 @default.
• W3036860913 hasRelatedWork W1990719269 @default.
• W3036860913 hasRelatedWork W1995515455 @default.
• W3036860913 hasRelatedWork W2026275708 @default.
• W3036860913 hasRelatedWork W2080531066 @default.
• W3036860913 hasRelatedWork W2748952813 @default.
• W3036860913 hasRelatedWork W2899084033 @default.
• W3036860913 hasRelatedWork W29449857 @default.
• W3036860913 hasRelatedWork W3031052312 @default.
• W3036860913 hasRelatedWork W3032375762 @default.
• W3036860913 hasVolume "39" @default.
• W3036860913 isParatext "false" @default.
• W3036860913 isRetracted "false" @default.
• W3036860913 magId "3036860913" @default.
• W3036860913 workType "article" @default.