{"doi":"10.3389/ti.2025.14848","title":"Chronic Lung Allograft Dysfunction in Patients Receiving Lung Transplantation for COVID-19 ARDS","abstract":"reflecting distinct immune activation or airway injury patterns after severe viral ARDS. In multivariable models, only BMI predicted CLAD (HR 1.07, CI 1.01-1.14; p=0.03). Donorspecific antibodies, CMV infection, acute rejection, and transplant type were not significant predictors (Supplemental Table 1). Although the coronavirus pandemic has subsided, lung transplantation remains a salvage option for patients with COVID-related respiratory failure and is currently being studied as a treatment for ARDS. 9 In this single-center case series, we report a 22% incidence of CLAD in CARDS patients undergoing lung transplantation, with an average follow-up of 1,079 days. This rate is not significantly different from the incidence in patients transplanted for other indications within our cohort (21%, p = 1.00) or from the 30% incidence reported at 1,095 days in international data. 8 These findings highlight the potential for long-term graft sustainability in this population and provide valuable single-center evidence on the feasibility of lung transplantation for ARDS in the post-COVID era. CARDS recipients demonstrated significantly higher rates of PGD grade 3 compared to non-CARDS recipients (58.3% vs. 38.0%, p = 0.02), a key risk factor for CLAD. 10 Interpretation of this finding is complex, as the acute manifestations of CARDS-including inflammation, endothelial dysfunction, and pulmonary edema-can require prolonged ECMO support and impact PGD diagnostic criteria. Elevated PGD rates in CARDS patients may reflect acute disease severity rather than the traditional PGD pathophysiology described in lung transplant recipients with more chronic disease. Notably, only BMI was a significant predictor of CLAD in our 252-patient cohort (HR 1.07, CI 1.01-1.14, p = 0.03). Known risk factors such as PGD grade 3 was not significant. [7][8][9][10] This may reflect the limited sample size and the time-dependent nature of CLAD. This study has several limitations, including modest sample size and mid-term follow-up, as well as a higher incidence of bilateral lung transplants in CARDS patients, which is associated with a longer time to CLAD diagnosis by a median of 150 days. In addition, 29 patients which died within the first year were excluded from the CLAD analysis. While this approach was necessary to meet the diagnostic definition of CLAD, it introduces the possibility of selection bias. We also acknowledge that death represents a competing risk when evaluating CLAD incidence, which was not formally modeled in this study. CARDS recipients in our cohort were younger and overall healthier compared with typical lung transplant candidates, which could partly explain the comparable CLAD rates observed. Although our study focused on CARDS, these findings may have implications for other acute respiratory failure syndromes, such as influenza-related ARDS; however, further research is needed before generalizing these results to other indications. In summary, our findings suggest CARDS is not associated with increased CLAD risk, and longterm outcomes remain favorable. Multi-center studies with extended follow-up are warranted.","journal":"Transplant International","year":2025,"id":579922,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9448,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1122604,"name":"Taisuke Kaiho","orcid":"0009-0003-1056-5929","position":1,"is_corresponding":false},{"id":948456,"name":"Austin Chang","orcid":"0000-0001-7343-6874","position":2,"is_corresponding":false},{"id":1490390,"name":"Yudai Miyashita","orcid":"0000-0001-8959-3823","position":3,"is_corresponding":false},{"id":943119,"name":"Takahide Toyoda","orcid":"0000-0003-4766-5221","position":4,"is_corresponding":false},{"id":422850,"name":"Ambalavanan Arunachalam","orcid":"0000-0002-0363-7889","position":5,"is_corresponding":false},{"id":232806,"name":"Ankit Bharat","orcid":"0000-0002-1248-0457","position":6,"is_corresponding":false},{"id":230873,"name":"G. R. Scott Budinger","orcid":"0000-0002-3114-5208","position":7,"is_corresponding":false},{"id":232809,"name":"Chitaru Kurihara","orcid":"0000-0003-3536-4675","position":8,"is_corresponding":false},{"id":946236,"name":"Benjamin Louis Thomae","orcid":"0000-0001-5065-9696","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T02:58:34.718602Z","pmid":"41262158","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}