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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. May 29, 2020; 10(5): 104-116
Published online May 29, 2020. doi: 10.5500/wjt.v10.i5.104
Chronic lung allograft dysfunction post-lung transplantation: The era of bronchiolitis obliterans syndrome and restrictive allograft syndrome
Nobuyuki Yoshiyasu, Masaaki Sato
Nobuyuki Yoshiyasu, Masaaki Sato, Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
Author contributions: Yoshiyasu N and Sato M equally contributed to this paper in the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Masaaki Sato, MD, PhD, Director, Department of Thoracic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. satom-sur@h.u-tokyo.ac.jp
Received: February 24, 2020
Peer-review started: February 24, 2020
First decision: April 25, 2020
Revised: April 30, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: May 29, 2020
Processing time: 95 Days and 1.7 Hours
ARTICLE HIGHLIGHTS

Currently, CLAD is mainly classified into two clinical phenotypes, BOS and RAS. These mechanisms are not clear but considered to involve complex immune-mediated mechanisms such as innate immunity, cellular immunity, humoral immunity and autoimmunity. Finally, tissue remodeling takes place, resulting in irreversible fibrosis. An apparent histological difference between BOS and RAS is the anatomical locations involved: namely, BOS mainly involves small airways while peripheral lung tissue remains relatively intact, while RAS involves multiple anatomical compartments including airways, pleura, interlobular septum, alveoli, and vasculature. Such difference in the distribution of fibrosis may be associated with different magnitude and quality of immune mechanisms including lymphoid neogenesis.