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Lung Transplantation: Current Challenges and New Perspectives
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Lung Transplantation: Current Challenges and New Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: closed (20 January 2026) | Viewed by 1962

Special Issue Editors

Dr. Reinaldo E. Rampolla

E-Mail Website
Guest Editor
Department of Pulmonary and Critical Care Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Interests: lung transplantation; organ donation; transplant care
Dr. Pedro A. Catarino

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Interests: lung transplant; heart transplant; aortic surgery

Special Issue Information

Dear Colleagues,

Lung transplantation remains a life-saving intervention for patients with end-stage lung diseases such as idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, cystic fibrosis, and pulmonary arterial hypertension. This Special Issue on lung transplantation brings together leading research and expert perspectives to address critical developments and persistent challenges in the field.

The articles featured in this issue will cover a broad range of topics, from innovations in organ preservation and ex vivo lung perfusion to advances in recipient selection.

By integrating clinical insights with cutting-edge research, this issue aims to support multidisciplinary teams in optimizing outcomes for lung transplant recipients. The collection provides a valuable resource for clinicians committed to advancing lung transplantation as a sustainable and effective therapy for end-stage lung disease.

Dr. Reinaldo E. Rampolla
Dr. Pedro A. Catarino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung transplantation
  • interstitial lung diseases
  • pulmonary hypertension
  • chronic obstructive pulmonary disease
  • bronchiectasis
  • extra corporeal membrane oxygenation
  • robotic lung transplantation

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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12 pages, 610 KB  
Article
HLA-DQ7 De Novo Donor-Specific Antibodies Are Associated with Increased Risk of Chronic Lung Allograft Dysfunction After Lung Transplantation
by Maximilian Vorstandlechner, Julia Walter, Christian P. Schneider, Nicole Samm, Sebastian Michel, Paola Arnold, Roland Tomasi, Andrea Dick and Teresa Kauke
J. Clin. Med. 2026, 15(4), 1608; https://doi.org/10.3390/jcm15041608 - 19 Feb 2026
Viewed by 476
Abstract
Background/Objectives: Chronic lung allograft dysfunction (CLAD) remains the leading cause of late graft failure after lung transplantation (LuTX). De novo donor-specific anti-HLA antibodies (dnDSA), especially HLA-DQ, have been implicated; we assessed associations between dnDSA (class and specificity) and CLAD after LuTX. Methods [...] Read more.
Background/Objectives: Chronic lung allograft dysfunction (CLAD) remains the leading cause of late graft failure after lung transplantation (LuTX). De novo donor-specific anti-HLA antibodies (dnDSA), especially HLA-DQ, have been implicated; we assessed associations between dnDSA (class and specificity) and CLAD after LuTX. Methods: We retrospectively analyzed all LuTX recipients transplanted from 2005–2018 at a single center (n = 585). dnDSA were measured by Luminex single-antigen bead assays (MFI > 1000) at 1, 3, 6, and 12 months and at least annually thereafter. CLAD was defined by ISHLT criteria; time-to-event comparisons used log-rank testing. Results: dnDSA developed in 151/585 recipients (25.8%), predominantly class II (129/585; 22.1%); class I dnDSA occurred in 52/585 (8.9%). CLAD occurred more frequently in dnDSA-positive than dnDSA-negative recipients (64/151; 42.4% vs. 109/434; 25.1%; p < 0.0001). Rejection-attributed death was higher in dnDSA-positive recipients (19/151; 11.3% vs. 25/434; 5.3%; p = 0.01). Both class I and class II dnDSA were associated with higher CLAD rates (log-rank p < 0.001 each). Locus-specific analyses identified HLA-DQ dnDSA as strongly associated with CLAD (p < 0.0001); DQ7 was the most frequent specificity (n = 44) and showed the strongest association (p < 0.0001). Conclusions: dnDSA after LuTX were associated with increased CLAD incidence and rejection-attributed mortality, with a prominent association for HLA-DQ—particularly DQ7. Full article
(This article belongs to the Special Issue Lung Transplantation: Current Challenges and New Perspectives)
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Review

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19 pages, 667 KB  
Review
Updates, Management, and Future of Diagnosing and Managing Chronic Lung Allograft Dysfunction
by Emily Gosche and Joshua B. Smith
J. Clin. Med. 2026, 15(4), 1543; https://doi.org/10.3390/jcm15041543 - 15 Feb 2026
Viewed by 635
Abstract
Lung transplantation provides a curative option for patients living with end-stage lung disease, with a goal of improving survival and quality of life. Chronic lung allograft dysfunction, or CLAD, represents a major cause of morbidity and mortality, particularly after the first year of [...] Read more.
Lung transplantation provides a curative option for patients living with end-stage lung disease, with a goal of improving survival and quality of life. Chronic lung allograft dysfunction, or CLAD, represents a major cause of morbidity and mortality, particularly after the first year of transplant. Background/Objectives: The goal of this review is to outline the diagnosis and management of CLAD within the lung transplant population, as well as discuss future areas of potential research interest. Methods: A PubMed literature review of relevant publications regarding CLAD epidemiology, diagnosis, and management was performed to assess current understandings. Results: CLAD is the leading cause of death in lung transplant patients following the first year of transplant, and is common, with approximately 50% of patients exhibiting some degree of CLAD within five years of surgery. Well-established guidelines on diagnosis were recently published to aid clinicians in diagnosing and characterizing CLAD. Several medical and surgical interventions exist, although no therapy consistently and reliably stabilizes or reverses CLAD. Conclusions: CLAD management remains a priority within the lung transplant field as a leading cause of morbidity and mortality. Full article
(This article belongs to the Special Issue Lung Transplantation: Current Challenges and New Perspectives)
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13 pages, 2829 KB  
Review
Interleukin-2 Receptor Antagonist Induction Therapy in Lung Transplantation—A Meta-Analysis of Reconstructed Time-to-Event Data
by Felipe S. Passos, Erlon de Avila Carvalho, Rachid E. Oliveira, Ricardo E. Treml, Hristo Kirov, Torsten Doenst, Bernardo M. Pessoa and Tulio Caldonazo
J. Clin. Med. 2026, 15(4), 1438; https://doi.org/10.3390/jcm15041438 - 12 Feb 2026
Viewed by 505
Abstract
Objectives: Lung transplantation is a life-saving option for patients with end-stage lung diseases, yet immunosuppression management remains challenging. Induction therapy with interleukin-2 receptor antagonists (IL2-AR), such as basiliximab and daclizumab, is designed to reduce acute rejection and improve graft survival. However, its efficacy [...] Read more.
Objectives: Lung transplantation is a life-saving option for patients with end-stage lung diseases, yet immunosuppression management remains challenging. Induction therapy with interleukin-2 receptor antagonists (IL2-AR), such as basiliximab and daclizumab, is designed to reduce acute rejection and improve graft survival. However, its efficacy compared with alternative agents or no induction therapy remains uncertain. This study aimed to evaluate the impact of IL2-AR induction on clinical outcomes in lung transplant recipients. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing IL2-AR induction with antithymocyte globulin (ATG), alemtuzumab, or no induction therapy were included. The primary outcomes were overall survival and freedom from acute rejection. Secondary outcomes included freedom from bronchiolitis obliterans syndrome (BOS), hospital length of stay (LOS), and time until extubation. Kaplan–Meier curves were reconstructed for long-term outcomes. Random effects model was performed. Results: Twelve studies comprising 27,855 patients were included. IL2-AR induction was associated with improved overall survival compared to standard of care (HR 0.88; 95%CI 0.85–0.93; p < 0.01). However, sensitivity analyses, including two-stage meta-analysis and leave-one-out analysis, revealed a loss of statistical significance. No significant differences were found for freedom from acute rejection (p = 0.774) or secondary outcomes, including freedom from BOS (p = 0.455), hospital LOS (p = 0.423), and time until extubation (p = 0.186). Conclusions: IL2-AR therapy may be associated with improved survival after lung transplantation; however, evidence remains inconclusive due to heterogeneity and limitations in study design. Full article
(This article belongs to the Special Issue Lung Transplantation: Current Challenges and New Perspectives)
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