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Molecular monitoring of lung allograft health: is it ready for routine clinical use?

Maintenance of long-term lung allograft health in lung transplant recipients (LTRs) requires a fine balancing act between providing sufficient immunosuppression to reduce the risk of rejection whilst at the same time not over-immunosuppressing individuals and exposing them to the myriad of immunosup...

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Autores principales: Pradère, Pauline, Zajacova, Andrea, Bos, Saskia, Le Pavec, Jérôme, Fisher, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663940/
https://www.ncbi.nlm.nih.gov/pubmed/37993125
http://dx.doi.org/10.1183/16000617.0125-2023
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author Pradère, Pauline
Zajacova, Andrea
Bos, Saskia
Le Pavec, Jérôme
Fisher, Andrew
author_facet Pradère, Pauline
Zajacova, Andrea
Bos, Saskia
Le Pavec, Jérôme
Fisher, Andrew
author_sort Pradère, Pauline
collection PubMed
description Maintenance of long-term lung allograft health in lung transplant recipients (LTRs) requires a fine balancing act between providing sufficient immunosuppression to reduce the risk of rejection whilst at the same time not over-immunosuppressing individuals and exposing them to the myriad of immunosuppressant drug side-effects that can cause morbidity and mortality. At present, lung transplant physicians only have limited and rather blunt tools available to assist them with this task. Although therapeutic drug monitoring provides clinically useful information about single time point and longitudinal exposure of LTRs to immunosuppressants, it lacks precision in determining the functional level of immunosuppression that an individual is experiencing. There is a significant gap in our ability to monitor lung allograft health and therefore tailor optimal personalised immunosuppression regimens. Molecular diagnostics performed on blood, bronchoalveolar lavage or lung tissue that can detect early signs of subclinical allograft injury, differentiate rejection from infection or distinguish cellular from humoral rejection could offer clinicians powerful tools in protecting lung allograft health. In this review, we look at the current evidence behind molecular monitoring in lung transplantation and ask if it is ready for routine clinical use. Although donor-derived cell-free DNA and tissue transcriptomics appear to be the techniques with the most immediate clinical potential, more robust data are required on their performance and additional clinical value beyond standard of care.
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spelling pubmed-106639402023-11-22 Molecular monitoring of lung allograft health: is it ready for routine clinical use? Pradère, Pauline Zajacova, Andrea Bos, Saskia Le Pavec, Jérôme Fisher, Andrew Eur Respir Rev Reviews Maintenance of long-term lung allograft health in lung transplant recipients (LTRs) requires a fine balancing act between providing sufficient immunosuppression to reduce the risk of rejection whilst at the same time not over-immunosuppressing individuals and exposing them to the myriad of immunosuppressant drug side-effects that can cause morbidity and mortality. At present, lung transplant physicians only have limited and rather blunt tools available to assist them with this task. Although therapeutic drug monitoring provides clinically useful information about single time point and longitudinal exposure of LTRs to immunosuppressants, it lacks precision in determining the functional level of immunosuppression that an individual is experiencing. There is a significant gap in our ability to monitor lung allograft health and therefore tailor optimal personalised immunosuppression regimens. Molecular diagnostics performed on blood, bronchoalveolar lavage or lung tissue that can detect early signs of subclinical allograft injury, differentiate rejection from infection or distinguish cellular from humoral rejection could offer clinicians powerful tools in protecting lung allograft health. In this review, we look at the current evidence behind molecular monitoring in lung transplantation and ask if it is ready for routine clinical use. Although donor-derived cell-free DNA and tissue transcriptomics appear to be the techniques with the most immediate clinical potential, more robust data are required on their performance and additional clinical value beyond standard of care. European Respiratory Society 2023-11-22 /pmc/articles/PMC10663940/ /pubmed/37993125 http://dx.doi.org/10.1183/16000617.0125-2023 Text en Copyright ©The authors 2023 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org
spellingShingle Reviews
Pradère, Pauline
Zajacova, Andrea
Bos, Saskia
Le Pavec, Jérôme
Fisher, Andrew
Molecular monitoring of lung allograft health: is it ready for routine clinical use?
title Molecular monitoring of lung allograft health: is it ready for routine clinical use?
title_full Molecular monitoring of lung allograft health: is it ready for routine clinical use?
title_fullStr Molecular monitoring of lung allograft health: is it ready for routine clinical use?
title_full_unstemmed Molecular monitoring of lung allograft health: is it ready for routine clinical use?
title_short Molecular monitoring of lung allograft health: is it ready for routine clinical use?
title_sort molecular monitoring of lung allograft health: is it ready for routine clinical use?
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663940/
https://www.ncbi.nlm.nih.gov/pubmed/37993125
http://dx.doi.org/10.1183/16000617.0125-2023
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