BACKGROUND: There are limited data on optimal management of chronic lung allograft dysfunction (CLAD). We aimed to describe the variability of diagnostic and therapeutic practices in Europe. METHODS: A structured questionnaire was sent to 71 centres in 24 countries. Questions were related to contemporary clinical practices for workup, monitoring and treatment of CLAD. The number of lung transplant procedures and patients in follow-up were collected. RESULTS: 44 centres (62%) responded from 20 countries, representing 74% of European activity. The prevalence of CLAD was estimated at 9.1 cases per million population (25th and 75th percentiles of 4.4, 15.7). Preferred initial workup for probable CLAD consisted of chest computed tomography (CT) (inspiratory 91% and expiratory 74%), donor-specific antibody (DSA) measurement (86%), bronchoalveolar lavage (BAL) (85%) and transbronchial biopsy (81%). For monitoring of definite CLAD, inspiratory CT (67%), DSA (61%) and BAL (43%) were preferred. Body plethysmography was unavailable for 16% of cases. Prophylaxis was based on preventing infections (cytomegalovirus 99%, inhaled antibiotics 70% and antifungals 65%), tacrolimus-based immunosuppression (96%), azithromycin (72%) and universal proton pump inhibitor treatment (84%). First-line treatment of CLAD was based on azithromycin (82%) and steroid augmentation (74%). Photopheresis was used in 26% of cases. CONCLUSION: Current European practice CLAD detection is based on spirometry, inspiratory CT and DSA, with limited access to plethysmography and expiratory CT. Prophylactic treatment is based on azithromycin, tacrolimus-based immunosuppression and treatment of risk factors. No single treatment strategy is universally used, highlighting the need for an effective treatment of CLAD. The preferred first-line strategy is azithromycin and steroid augmentation.

Center for Research in Transplantation and Translational Immunology Nantes France

Department of Cardiology Section for Lung Transplantation Heartcentre Rigshospitalet Copenhagen Denmark

Department of Chest Medicine Hôpital Universitaire de Bruxelles Brussels Belgium

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Medicine 5 Comprehensive Pneumology Center DZL LMU University Hospital LMU Munich Munich Germany

Department of Pneumology and Lung Transplantation Foch Hospital Suresne France

Department of Pneumology Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany

Department of Pulmonary Medicine Institute of Internal Medicine University of Gothenburg Gothenburg Sweden

Department of Pulmonary Medicine University Medicine Essen Ruhrlandklinik Essen Germany

Department of Respiratory Diseases Leuven Lung Transplant Program University Hospitals Leuven Leuven Belgium

Department of Respiratory Medicine and Infectious Diseases Hannover Medical School Hannover Germany

Department of Respiratory Medicine Erasmus University Medical Center Rotterdam Rotterdam The Netherlands

Dept CHROMETA Katholieke Universiteit Leuven Leuven Belgium

Division of Pulmonology Department of Internal Medicine Medical University of Graz Graz Austria

DSCTV University of Padua Padua Italy

Erasmus MC Transplant Institute Erasmus University Medical Center Rotterdam Rotterdam The Netherlands

European Reference Network of Rare Lung Diseases Frankfurt Germany

German Center for Lung Research Giessen Germany

Harefield Hospital and Imperial College London UK

Helsinki University Hospital Helsinki Finland

Hôpital Marie Lannelongue Le Plessis Robinson France

Hospices Civils de Lyon Centre de Transplantation Pulmonaire et Cardiopulmonaire Louis Pradel Hospital Lyon France

Hospital Universitario 12 de Octubre Madrid Spain

Hospital Universitario Puerta de Hierro de Majadahonda Majadahonda Spain

Institute of Transplantation Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne UK

Klinika Alergologii i Pneumonologii Gdański Uniwersytet Medyczny Gdansk Poland

Lung Transplant Center CHU UCL Namur Namur Belgium

Lung Transplant Program Hospital Universitari Vall Hebron Barcelona Spain

Lung Transplant Unit Respiratory Department Marqués de Valdecilla University Hospital Santander Spain

Mater University Hospital Dublin Ireland

Medical University Vienna Austria

Nantes Université CHU Nantes INSERM Service de Pneumologie L'institut du Thorax Nantes France

Oslo University Hospital Oslo Norway

Pauls Stradins Clinical University Hospital Riga Stradiņš University Riga Latvia

Prague Lung Transplant Program 3rd Department of Surgery 1st Faculty of Medicine Charles University Motol University Hospital Prague Czech Republic

Respiratory Diseases Unit University Hospital of Siena Siena Italy

Respiratory Medicine and Allergology Center Feofania Hospital Kyiv Ukraine

Respiratory Unit and Cystic Fibrosis Center Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Università degli Studi di Milano Milan Italy

Royal Papworth Hospital Respiratory Medicine Cambridge UK

Semmelweis University Department of Pulmonology Budapest Hungary

Skåne University Hospital Lund Sweden

Strasbourg Lung Transplant Program Université de Strasbourg Strasbourg France

University Hospital Giessen Giessen Germany

University Hospital Hamburg Eppendorf Hamburg Germany

University Hospital Leipzig Leipzig Germany

University Medical Centre Ljubljana Ljubljana Slovenia

Zürich Lung Transplant Program Zurich Switzerland

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