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.

Background: Respiratory tract infections (RTIs) are a leading cause of morbidity and mortality following lung transplantation (LTx). This study evaluated a point‐of‐care multiplex‐PCR testing system (POCTmPCR) for pathogen detection in various respiratory samples from LTx recipients. Methods: In a prospective single‐center study, LTx recipients with RTI undergoing bronchoscopy were enrolled. Samples from bronchoalveolar lavage (BAL), sputum, and nasopharyngeal swabs (NPS) were analyzed by POCTmPCR in conjunction with conventional diagnostics. The primary study endpoint was the concordance of POCTmPCR results between samples (DRKS00032359). Results: Fifty participants with a median age of 48 years were included; 28 (56%) were previously colonized. Using POCTmPCR, 44 bacterial pathogens were identified in BAL from 30 patients, 49 in sputum (30 patients), and 33 in NPS (17 patients). POCTmPCR identified 24 viral pathogens in BAL from 20 patients, 22 pathogens in sputum of 19 patients, and 19 in NPS of 19 patients. For viral POCTmPCR, sensitivity and specificity compared to BAL were 84% and 97% in sputum, and 80% and 97% in NPS, respectively. For bacterial POCTmPCR, sensitivity and specificity were 80% and 67% in sputum, and 37% and 85% in NPS, respectively. POCTmPCR in comparison to conventional workup had a sensitivity of 89% and 80% and specificity of 75% and 76% for viral and bacterial pathogens, respectively. Conclusion: POCTmPCR in nasal swabs and sputum may serve as an alternative to BAL for detecting respiratory viruses. Performance for bacterial detection in noninvasive samples was lower. The POCTmPCR system used lacks detection for SARS‐CoV‐2 and Aspergillus spp. image

Background.: Subnormal lung function after lung transplantation (LTx) has increasingly been recognized as an independent risk factor for mortality. Historically, baseline lung allograft dysfunction (BLAD) has been defined using the fixed “< 80% predicted” threshold from population-wide reference equations, which disregards age- and sex-related variability in spirometric values and can lead to systematic overdiagnosis, particularly in older and female recipients. While the lower limit of normal (LLN), derived from Global Lung Initiative reference equations, has been accepted as technical standard in spirometry, it has not yet been applied to define BLAD. Methods.: A retrospective multicenter study included LTx recipients transplanted between 2014 and 2018. Lung function trajectories and allograft survival were followed-up until August 2024. The association of BLAD defined by forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) < LNN as time-dependent variable with graft loss was studied using time-dependent Cox proportional hazard models. Results.: We analyzed 726 patients after LTx including 102 unilateral LTx recipients, of whom 470 (65%) of the cohort achieved normal baseline lung function defined as FEV1 and FVC ≥ LLN. Two hundred thirty-six patients experienced graft loss (n = 2 redo LTx) and 179 developed chronic lung allograft dysfunction. After adjusting for age, disease, transplant type, and chronic lung allograft dysfunction, baseline FEV1 or FVC < LLN was associated with graft loss (hazard ratio, 1.822; 95% confidence interval, 1.372-2.418; P < 0.001). Conclusions.: BLAD defined by concurrent baseline FEV1 or FVC below the LLN was strongly associated with increased risk of graft loss. These findings extend prior studies that used the fixed 80% threshold by demonstrating that an LLN-based, age- and sex-adjusted definition of BLAD identifies lung transplant recipients at risk, thereby avoiding fixed cutoff associated age- and sex-bias.

Background: Community-acquired pneumonia (CAP) is a common reason for presentation to the emergency department (ED), but accurate diagnosis is challenging due to overlapping and often nonspecific clinical features. Data on the frequency and spectrum of alternative diagnoses in patients initially diagnosed with CAP in the ED are limited. The aim of this study was to evaluate the diagnostic concordance of an initial ED diagnosis of CAP, characterize common alternative discharge diagnoses, and analyze clinical, laboratory, imaging utilization, and vital sign parameters associated with confirmed CAP. Methods: We conducted a retrospective analysis of diagnostic concordance and differential diagnoses in 1,385 adult patients who presented to the ED of Hannover Medical School and were initially diagnosed with CAP. Initial ED diagnoses were compared with discharge diagnoses. Results: The cohort comprised 37% female and 63% male patients with a median age of 71 years (IQR 58–79). Comparison between initial ED and discharge diagnoses demonstrated that suspected CAP was confirmed in 52% ( n = 663) of cases. The most common differential diagnoses were other pulmonary conditions ( n = 297, 41%), cardiac conditions ( n = 150, 21%), and renal conditions ( n = 95, 13%). Patients with confirmed CAP showed significantly higher C-reactive protein (CRP) levels (82 mg/L [IQR 37–159] vs. 57 mg/L [IQR 22–127]; p < 0.001) and slightly higher body temperature (37.1 °C [IQR 36.4–38.0] vs. 36.8 °C [IQR 36.2–37.7]; p < 0.001) than those with alternative diagnoses. Conclusion: Only about half of patients initially diagnosed with CAP in the emergency setting had a confirmed diagnosis at discharge, indicating that CAP in this context should be regarded as a working diagnosis rather than a definitive entity. Isolated laboratory, imaging, and vital sign parameters showed limited ability to distinguish CAP from alternative diagnoses, highlighting the importance of structured reassessment after admission to confirm or revise the initial diagnosis and to reduce misclassification and unnecessary antibiotic use.

Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridging strategy to lung transplantation. Long-term outcomes in this specific patient population after lung transplantation remain incompletely described. We investigated age-dependent long-term outcomes in adult lung transplant candidates on waiting list while receiving ECMO support. We performed a retrospective single-center cohort study including all adult patients listed for lung transplantation while receiving ECMO support between November 2010 and May 2025. Patients were stratified a priori by age at listing (<50 versus ≥50 years). The primary endpoint was 5-year post-transplant graft survival, defined as freedom from death or retransplantation. Secondary endpoints included comorbidities, frailty, exercise capacity, return to work, and patient-reported outcomes during outpatient follow-up. Among 1,493 patients listed for lung transplantation, 115 were listed while receiving ECMO support; 72 patients were aged <50 years and 43 patients were aged ≥50 years. Overall, 93 ECMO-listed patients (81%) underwent transplantation. One-, three-, and five-year post-transplant graft survival were 87%, 83%, and 77% in recipients aged <50 years compared with 72%, 53%, and 44% in recipients aged ≥50 years, respectively. Kaplan–Meier analysis demonstrated a significant difference between age groups. Recipient age ≥50 years was independently associated with an increased risk of graft loss in multivariable analysis (adjusted HR 2.53, 95% CI 1.14–5.59; p=0.022). Among patients reaching outpatient follow-up, older recipients had a slightly higher comorbidity burden, reduced exercise capacity, and lower rates of return to work, while Clinical Frailty Scale ≥4 remained relatively uncommon. In this 15-year single-center experience, recipient age ≥50 years was independently associated with inferior graft survival after ECMO-bridged lung transplantation. These findings support careful, function-oriented selection of older ECMO-supported candidates.