TY - JOUR T1 - Prediction of chronic lung allograft dysfunction: a systems medicine challenge JF - European Respiratory Journal JO - Eur Respir J SP - 689 LP - 693 DO - 10.1183/09031936.00161313 VL - 43 IS - 3 AU - Christophe Pison AU - Antoine Magnan AU - Karine Botturi AU - Michel Sève AU - Sophie Brouard AU - Benjamin J. Marsland AU - Florian Ernst AU - Tobias Paprotka AU - Kevin Deplanche AU - Andreas Fritz AU - Valérie Siroux AU - Jean-Pierre Boissel AU - Paul A. Corris AU - Charles Auffray AU - Laurent P. Nicod Y1 - 2014/03/01 UR - http://erj.ersjournals.com/content/43/3/689.abstract N2 - The International Society for Heart and Lung Transplantation registry recorded that 3631 adult heart-lung transplants and 39 835 adult lung transplants have been performed in centres throughout the world up to 2012, establishing lung transplantation (LT) as the standard of care for selected patients with end-stage respiratory disease [1]. The long-term success of LT is limited by chronic lung allograft dysfunction (CLAD), of which the two most common phenotypes are an abnormal remodelling of the small airways resulting in progressive airflow obstruction called bronchiolitis obliterans syndrome (BOS) and, less frequently, a restrictive ventilatory process referred to as restrictive allograft syndrome (RAS) [2, 3]. Almost 50% of LT recipients will develop CLAD within 5 years post-LT, rising to 75% after 10 years [1]. Despite a range of therapeutic approaches, median survival figures from the time of diagnosis remain very poor at ∼2 years, resulting in 27% overall 10-year survival, the poorest long-term survival after solid-organ transplantations for the period of 2000–2008 in the USA [4].In clinical practice, CLAD is a diagnosis of exclusion once the possible confounding diseases related either to allograft, such as persistent acute rejection, azithromycin-reversible allograft dysfunction, infection, anastomotic stricture, disease recurrence, and/or to extra-allograft complications, such as pleural disease, diaphragm dysfunction or native lung hyperinflation, have been ruled out. CLAD diagnosis relies on persistent and irreversible decline ≥20% in post-bronchodilator mean of two best forced expiratory volume in 1 s (FEV1) and/or forced vital capacity (FVC) measurements for >3 weeks, accordingly to a new proposed classification for CLAD. [3]. Pulmonary functional tests are used to define CLAD since pathology samplings display important limitations [3]. Treating CLAD remains a challenge because underlying molecular events and triggers are not well understood and unfortunately are … ER -