Late Breaking Abstract - CLAD phenotype determines post-CLAD outcome: a contemporary single center analysis

<bold>Background:</bold> Chronic Lung Allograft Dysfunction (CLAD) is the main long-term complication limiting survival after lung transplantation (LTx). Graft survival after CLAD onset may vary according to the CLAD phenotype at CLAD diagnosis. However, data on actual post-CLAD graft survival in large LTx cohorts are limited. <bold>Methods:</bold> All LTx recipients transplanted between 2010 and 2022 (n=918) in our center were assessed for their CLAD status according to the 2019 ISHLT consensus report. Patients with definite CLAD were stratified by CLAD phenotype (BOS/Mixed/RAS), and graft survival after CLAD onset (censored as of February 2024) was analyzed using a log-rank test, visualized by Kaplan-Meier survival curves. <bold>Results:</bold> A total of 252 patients (27.5%) with CLAD were included. Thorough assessment of clinical features and evolution over time allowed all initially ‘undefined’ patients at CLAD onset (n=15) to be re-categorized as either non-CLAD (i.e. other plausible cause for functional decline) or CLAD (mainly BOS). As a result, n=172 (68.3%) BOS, n=18 (7.1%) Mixed and n=62 (24.6%) RAS patients were identified. Median graft survival after CLAD onset was significantly better in BOS vs. Mixed vs. RAS: 5.8 years vs. 3.2 years vs. 1.3 year, respectively (p<0.0001). <bold>Conclusion:</bold> Contemporary post-CLAD outcome remains severely limited, highlighting the need for better therapeutic options for CLAD prevention and treatment. <fig><object-id>erj;64/suppl_68/PA591/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>