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Peer-reviewedCC BY-NC 4.0ERJ Open Research

Possible baseline lung allograft dysfunction within the first year defines a high-risk and potentially reversible state after lung transplantation

  • Michael Gerckens1,2
  • Aorchie Siddiqui1
  • Julian Schlatzer1
  • Gamze Kasman1
  • Paola Arnold1
  • Jürgen Barton1
  • Tobias Veit1
  • Teresa Kauke2,3
  • Christian Schneider2,3
  • Sebastian Michel2,4
  • Michael Zoller5
  • Ali Önder Yildirim2,6
3 more authors
  • Jürgen Behr1
  • Nikolaus Kneidinger1,7
  • Carlo Mümmler1,2
7 affiliations
  1. 1Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), Munich, Germany
  2. 2Institute of Lung Health and Immunity (LHI), CPC, Helmholtz Munich, Member of the DZL, Munich, Germany
  3. 3Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
  4. 4Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
  5. 5Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
  6. 6Institute of Experimental Pneumology, LMU University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
  7. 7Department of Internal Medicine, Division of Respiratory Medicine, Lung Research Cluster, Medical University of Graz, Graz, Austria
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Abstract

Background: Baseline lung allograft dysfunction (BLAD) has been associated with impaired long-term outcomes. However, BLAD within the first post-transplant year represents a potentially dynamic state. This is the first study evaluating a provisional Possible BLAD state, investigating risk factors and evolution to normal baseline lung function or confirmed BLAD.

Methods: Possible BLAD was defined as failure to reach baseline forced expiratory volume in 1 s and forced vital capacity (FVC) ≥lower limit of normal within the first post-transplant year. Association of Possible BLAD and BLAD with allograft failure was investigated using multivariate time-dependent Cox regression analysis.

Results: Among lung allograft recipients in the Munich Lung Transplant cohort, Possible BLAD occurred in a substantial share of lung allograft recipients. Possible BLAD was independently associated with a markedly increased risk of allograft failure (HR 4.76, 95% CI 2.64–8.61). Patients who recovered from Possible BLAD to normal baseline lung function had similar survival compared to lung allograft recipients directly reaching normal baseline lung function. A four-item clinical score at timepoint of first spirometry predicted recovery from possible BLAD (area under the curve (AUC) 0.83 for double lung allograft recipients, AUC 0.88 for single lung allograft recipients).

Conclusion: Possible BLAD is associated with a markedly increased risk of mortality. A share of patients with Possible BLAD may recover to normal baseline lung function, while others progress to BLAD. Possible BLAD characterisation improves early risk stratification and might provide further insight into modifiable mechanisms underlying impaired allograft performance.

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Cite

BibTeXRIS
BibTeX
@article{gerckens2026possible,
  title = {{Possible baseline lung allograft dysfunction within the first year defines a high-risk and potentially reversible state after lung transplantation}},
  author = {Michael Gerckens and Aorchie Siddiqui and Julian Schlatzer and Gamze Kasman and Paola Arnold and Jürgen Barton and Tobias Veit and Teresa Kauke and Christian Schneider and Sebastian Michel and Michael Zoller and Ali Önder Yildirim and Jürgen Behr and Nikolaus Kneidinger and Carlo Mümmler},
  journal = {ERJ Open Research},
  year = {2026},
  month = sep,
  doi = {10.1183/23120541.00548-2026},
  url = {https://doi.org/10.1183/23120541.00548-2026},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Possible baseline lung allograft dysfunction within the first year defines a high-risk and potentially reversible state after lung transplantation
AU  - Michael Gerckens
AU  - Aorchie Siddiqui
AU  - Julian Schlatzer
AU  - Gamze Kasman
AU  - Paola Arnold
AU  - Jürgen Barton
AU  - Tobias Veit
AU  - Teresa Kauke
AU  - Christian Schneider
AU  - Sebastian Michel
AU  - Michael Zoller
AU  - Ali Önder Yildirim
AU  - Jürgen Behr
AU  - Nikolaus Kneidinger
AU  - Carlo Mümmler
PY  - 2026
DA  - 2026/09/01
JO  - ERJ Open Research
DO  - 10.1183/23120541.00548-2026
UR  - https://doi.org/10.1183/23120541.00548-2026
AB  - Background: Baseline lung allograft dysfunction (BLAD) has been associated with impaired long-term outcomes. However, BLAD within the first post-transplant year represents a potentially dynamic state. This is the first study evaluating a provisional Possible BLAD state, investigating risk factors and evolution to normal baseline lung function or confirmed BLAD.  Methods: Possible BLAD was defined as failure to reach baseline forced expiratory volume in 1 s and forced vital capacity (FVC) ≥lower limit of normal within the first post-transplant year. Association of Possible BLAD and BLAD with allograft failure was investigated using multivariate time-dependent Cox regression analysis.  Results: Among lung allograft recipients in the Munich Lung Transplant cohort, Possible BLAD occurred in a substantial share of lung allograft recipients. Possible BLAD was independently associated with a markedly increased risk of allograft failure (HR 4.76, 95% CI 2.64–8.61). Patients who recovered from Possible BLAD to normal baseline lung function had similar survival compared to lung allograft recipients directly reaching normal baseline lung function. A four-item clinical score at timepoint of first spirometry predicted recovery from possible BLAD (area under the curve (AUC) 0.83 for double lung allograft recipients, AUC 0.88 for single lung allograft recipients).  Conclusion: Possible BLAD is associated with a markedly increased risk of mortality. A share of patients with Possible BLAD may recover to normal baseline lung function, while others progress to BLAD. Possible BLAD characterisation improves early risk stratification and might provide further insight into modifiable mechanisms underlying impaired allograft performance.
SN  - 2312-0541
ER  -