Brun Anne-Laure, Chabi Marie-Laure, Picard Clément, Mellot François, Grenier Philippe A
Radiology Department, Hôpital Foch, 92150 Suresnes, France.
Respiratory Department, Hôpital Foch, 92150 Suresnes, France.
Diagnostics (Basel). 2021 Apr 30;11(5):817. doi: 10.3390/diagnostics11050817.
Chronic lung allograft rejection remains one of the major causes of morbi-mortality after lung transplantation. The term Chronic Lung Allograft Dysfunction (CLAD) has been proposed to describe the different processes that lead to a significant and persistent deterioration in lung function without identifiable causes. The two main phenotypes of CLAD are Bronchiolitis Obliterans Syndrome (BOS) and Restrictive Allograft Syndrome (RAS), each of them characterized by particular functional and imaging features. These entities can be associated (mixed phenotype) or switched from one to the other. If CLAD remains a clinical diagnosis based on spirometry, computed tomography (CT) scan plays an important role in the diagnosis and follow-up of CLAD patients, to exclude identifiable causes of functional decline when CLAD is first suspected, to detect early abnormalities that can precede the diagnosis of CLAD (particularly RAS), to differentiate between the obstructive and restrictive phenotypes, and to detect exacerbations and evolution from one phenotype to the other. Recognition of early signs of rejection is crucial for better understanding of physiopathologic pathways and optimal management of patients.
慢性肺移植排斥反应仍然是肺移植术后主要的发病和死亡原因之一。“慢性肺移植功能障碍”（CLAD）这一术语已被提出，用于描述导致肺功能显著且持续恶化但无明确病因的不同过程。CLAD的两种主要表型是闭塞性细支气管炎综合征（BOS）和限制性移植综合征（RAS），它们各自具有特定的功能和影像学特征。这些实体可能相关联（混合表型），也可能从一种转变为另一种。如果CLAD仍然是基于肺量计的临床诊断，计算机断层扫描（CT）在CLAD患者的诊断和随访中起着重要作用，在首次怀疑CLAD时排除功能下降的可识别原因，检测CLAD诊断之前可能出现的早期异常（特别是RAS），区分阻塞性和限制性表型，以及检测病情加重和从一种表型向另一种表型的演变。识别排斥反应的早期迹象对于更好地理解病理生理途径和优化患者管理至关重要。
