Image symbolizing lung transplant success and the importance of monitoring lung function.

Lung Transplant Success: How Early Detection of Dysfunction Can Save Lives

Theo Raines in Health & Wellness December 2025 • 4 min read.

"A new study reveals the importance of monitoring lung function after a transplant to improve long-term outcomes."

Lung transplants offer a lifeline to individuals with end-stage lung disease, providing them with a chance to breathe easier and live longer. However, the journey doesn't end with the surgery. Chronic lung allograft dysfunction (CLAD) remains a significant obstacle to long-term success, affecting many transplant recipients. CLAD encompasses conditions like bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD), both of which can severely impact lung function and overall survival.

A recent study published in The Journal of Heart and Lung Transplantation sheds light on the critical importance of monitoring lung function in the early stages after the onset of CLAD. The research focuses on changes in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) to determine how these changes can predict longer-term outcomes.

This article breaks down the study's findings, explaining why early detection of pulmonary function decline is vital and what it means for those who have undergone or are considering lung transplantation. We'll explore the significance of these findings in a way that's easy to understand, offering hope and actionable insights for patients and their families.

Why Early Lung Function Matters After a Transplant

Image symbolizing lung transplant success and the importance of monitoring lung function.

Chronic lung allograft dysfunction (CLAD) is a major complication following lung transplantation. It includes phenotypes like bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD), both leading causes of late death after the procedure. Understanding how lung function changes after CLAD onset is crucial.

The study, conducted by Jamie L. Todd et al., examined changes in FEV1 and FVC within the first 18 months after CLAD onset. FEV1 measures the amount of air you can forcefully exhale in one second, while FVC measures the total amount of air you can exhale after taking a deep breath. Declines in these measurements can indicate worsening lung function and potential graft failure.

FEV1: Measures how much air you can exhale in one second.
FVC: Measures the total amount of air you can exhale.
CLAD: Chronic lung allograft dysfunction, a major post-transplant complication.
BOS & R-CLAD: Phenotypes of CLAD that affect lung function.

Researchers retrospectively analyzed 216 bilateral lung transplant recipients with CLAD, including 65 with R-CLAD and 151 with BOS. They found that the most significant decreases in FEV1 and FVC occurred within the first six months after CLAD onset. Moreover, a decline of 10% or more in either FEV1 or FVC within this period was associated with a significantly increased risk of graft loss.

What This Means for Lung Transplant Patients

The study underscores the importance of vigilant monitoring of lung function following transplantation. Regular pulmonary function tests (PFTs) can help detect early signs of CLAD and identify patients at higher risk of graft loss. Early intervention and treatment may help stabilize lung function and improve long-term outcomes. If you've had a lung transplant, talk to your healthcare team about the best monitoring schedule for you.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.healun.2018.10.006, Alternate LINK

Title: Prognostic Significance Of Early Pulmonary Function Changes After Onset Of Chronic Lung Allograft Dysfunction

Subject: Transplantation

Journal: The Journal of Heart and Lung Transplantation

Publisher: Elsevier BV

Authors: Jamie L. Todd, Megan L. Neely, C.A. Finlen Copeland, Courtney W. Frankel, John M. Reynolds, Scott M. Palmer

Published: 2019-02-01

Everything You Need To Know

What is chronic lung allograft dysfunction (CLAD), and why is it a concern after a lung transplant?

Chronic lung allograft dysfunction (CLAD) is a major complication that can occur after a lung transplant. It refers to long-term problems with the transplanted lungs. CLAD includes conditions such as bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD). Both BOS and R-CLAD can severely reduce lung function, making it difficult for the recipient to breathe and ultimately affecting their long-term survival. Monitoring and early detection of CLAD are crucial to improving patient outcomes, but it does not mention other potential complications like infections or rejection episodes that can also impact long-term success. These other elements could occur concurrently or separately, leading to different challenges in patient management.

How do forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) relate to lung transplant outcomes?

Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are key measurements of lung function. FEV1 measures the amount of air a person can forcefully exhale in one second, while FVC measures the total amount of air a person can exhale after taking a deep breath. Declines in FEV1 and FVC after a lung transplant can indicate worsening lung function and the onset of chronic lung allograft dysfunction (CLAD), including bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD). A significant decrease in either FEV1 or FVC, especially early after CLAD onset, is associated with a higher risk of graft loss. FEV1 and FVC are not the only indicators, however. Other pulmonary function tests, imaging studies, and clinical assessments also play a role in comprehensively evaluating lung health and identifying potential problems.

The research mentions that the most significant decrease in FEV1 and FVC occurred within the first six months after CLAD onset. Why is this period so critical?

The first six months after the onset of chronic lung allograft dysfunction (CLAD), which includes bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD), are critical because this is when the most rapid decline in lung function, as measured by forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), typically occurs. A decline of 10% or more in either FEV1 or FVC during this period significantly increases the risk of graft loss. Early detection during this period allows for timely intervention, potentially slowing the progression of CLAD and improving long-term outcomes. However, further research could examine the specific mechanisms driving this rapid decline to develop targeted therapies that prevent or reverse it.

If I've had a lung transplant, what steps should I take to monitor my lung function, and how can early detection of CLAD impact my treatment?

If you've had a lung transplant, regular monitoring of your lung function is essential. This typically involves undergoing pulmonary function tests (PFTs) to measure your forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Detecting chronic lung allograft dysfunction (CLAD), including phenotypes like bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD), early allows your healthcare team to implement interventions, such as adjusting immunosuppression or starting other treatments, to stabilize your lung function and potentially improve your long-term outcome. Discuss with your healthcare team the best monitoring schedule for you. The text emphasizes the importance of PFTs, but not the importance of reporting symptoms like shortness of breath or cough, which can also lead to earlier interventions.

How does the differentiation between bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD) affect treatment strategies and patient outcomes following lung transplantation?

Bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD) are distinct phenotypes of chronic lung allograft dysfunction (CLAD) that manifest differently and may require tailored treatment strategies. BOS is characterized by airflow obstruction, while R-CLAD involves restrictive lung physiology. Recognizing these differences is essential because some therapies may be more effective for one phenotype than the other. Tailoring treatment to the specific type of CLAD can potentially improve patient outcomes by addressing the underlying mechanisms driving lung dysfunction. The text doesn't delve into the specifics of those treatments. Understanding the molecular pathways and immunological factors unique to BOS and R-CLAD could lead to the development of targeted therapies that more effectively prevent or reverse these conditions.