Chronic Lung Allograft Dysfunction Is Associated with Significant Disability after Lung Transplantation—A Burden of Disease Analysis in 1025 Cases

HIGHLIGHTS: What are the main findings? One out of four lung transplant recipients in the largest German center develop chronic lung allograft dysfunction (CLAD), which corresponds to chronic lung transplant rejection. Transplant patients who develop severe CLAD subsequently lose more than two disability-adjusted life years (DALYs). What are the implications of the main findings? As CLAD disability slowly develops within a median of two years after lung transplantation, there is room for better management of CLAD. Beyond already existing options (azithromycin, tacrolimus), new options have to be found for the prevention of CLAD. ABSTRACT: Background: Chronic lung allograft dysfunction (CLAD) is the leading cause of death after the first postoperative years of lung transplantation (LTx). Objective: To assess the number of disability-adjusted life years (DALYs) per patient with severe CLAD. Methods: The clinical and demographic data of patients who received their lung transplantation between 2010 and 2020 in the Hanover Medical School (Germany) were evaluated. Results: A total of 1025 lung transplant patients were followed for a median of 51 months (4.25 years); the median age at transplantation was 52.8 (interquartile range (IQR) 19) years. More than a quarter of transplant patients (271/1025 or 26.4%) developed CLAD, mostly (60%) of the bronchiolitis obliterans syndrome (BOS) phenotype. Of the CLAD patients, 99, or 36.5%, suffered from significant disability, which on average occurred after 2 years (IQR 2.55). The survival of CLAD patients with disability after transplantation was significantly lower compared to that of patients without CLAD (median 4.04 versus 5.41 years). Adjusted to the DALY estimation approach, CLAD patients lost 1.29 life years (YLL) and lived for 0.8 years with their disability (YLD), adding up to 2.09 DALYs (range 1.99–2.72) per patient. Conclusions: CLAD after lung transplantation is a major public health problem and is associated with substantial disability and costs. Further work is needed to develop therapeutic interventions that reduce its development.