Abstract
Background: CLAD including restrictive allograft syndrome (RAS) and bronchiolitis obliterans syndrome (BOS)is the main limitation in long-term survival after lung transplantation (LT); no predictive model of CLAD exists.
Methods: SysCLAD is a prospective study of LT in 14 centers by merging STCS3 and COLT1 prospective cohorts including “clinicome”, environmental pollution, lung microbiome, exome sequencing, blood and BAL proteomics, blood transcriptomics and immunological assays collected at months 6 and 12 post LT to identify signature or biomarkers that will predict CLAD by year-3 post LT by a systems medicine approach (Pison et al. Eur Respir J 2014;43:689). Based on FEV1, FVC, TLC, FEV1/FCV, clinical files and CT (Verleden et al. JHLT 2014;33:127), a SysCLAD multidisciplinary adjudication committee held 3 times in 2013 identified by year-3, 4 phenotypes: stable, BOS, RAS and mix-RAS as RAS with an obstructive ventilatory defect.
Results: between 2008 and 2013, 1 050 LT recipients were included. The first 425 patients were analysed: 51% male, 45±16 yrs old, 32±17 months follow-up, survival at 1, 2, 3, 4 and 5-year of 88, 82, 78, 76, 69% respectively. Among the 143 reaching 3 years alive we identified 83 stables, 38 BOS, 16 RAS and 6 mixed RAS cases, as a “novel” phenotype.
Conclusion: By 2013, 1050 LT within 14 clinical centres were included in SysCLAD with a complete data base allowing to define 4 robust phenotypes by year-3 post LT: stable, BOS, RAS, mixed RAS, essential step in SysCLAD to promote a prediction within year-1 post LT before any decline in lung function. Funds from VLM, PHRC, STCS, FP-7.
- © 2014 ERS