{"title":"Timing of lung transplant evaluation: considerations, barriers and alternatives.","authors":"Eline A van der Ploeg, Tjerk H Hylkema, C Tji Gan","doi":"10.1097/MCP.0000000000001176","DOIUrl":"10.1097/MCP.0000000000001176","url":null,"abstract":"<p><strong>Purpose of review: </strong>Over the past decade, increased knowledge has contributed to improved medical and technical treatments across the spectrum of respiratory diseases. As a result, timing for transplant evaluation might be more challenging. In this review, the focus is on timing of lung transplant evaluation of patients from the main respiratory diseases referred. Disease-specific predictors of survival in relation to timing of transplant evaluation and alternative treatments will be reviewed.</p><p><strong>Recent findings: </strong>Treatment options have evolved for respiratory diseases like chronic obstructive pulmonary disease, pulmonary fibrosis, cystic fibrosis and pulmonary arterial hypertension. These treatments have led to improved quality of life, exercise tolerance, lung function and outcome. However, the effect of these alternative treatments on transplant candidacy and knowledge on timing of lung transplant evaluation are lacking.</p><p><strong>Summary: </strong>This article reviews the current best evidence to guide clinicians regarding the optimum timing for transplant referral and highlights considerations to optimize transplant candidacy and outcomes.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"354-358"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The search for peripheral tolerance in lung transplantation.","authors":"Mark E Snyder, John F McDyer","doi":"10.1097/MCP.0000000000001180","DOIUrl":"10.1097/MCP.0000000000001180","url":null,"abstract":"<p><strong>Purpose of review: </strong>Median survival after lung transplantation is 5.7 years, which lags behind other solid organ transplants, such as heart, liver, and kidney. The major barrier to long-term survival in lung transplant recipients is chronic lung allograft dysfunction (CLAD). This review discusses the challenge of CLAD as a barrier to tolerance and identifies key areas in the field that require further development.</p><p><strong>Recent findings: </strong>CLAD is a heterogenous disease in its kinetics of onset and severity and remains a clinical diagnosis of exclusion, based on a decline in allograft function. While acute cellular rejection and antibody-mediated rejection are major risk-factors for CLAD, other barriers to long-term allograft acceptance are aspiration and primary graft dysfunction. However infections, particularly respiratory viral infections and Cytomegalovirus (CMV) remain the most significant risks for CLAD. Additionally, the lung transplant field is limited by a lack of molecular diagnostic assays for CLAD. Further, new targets are needed for precision immunosuppression, and more studies are needed to develop novel interventions to extend allograft acceptance.</p><p><strong>Summary: </strong>This review discusses new lines of study to address important unmet needs necessary to extend lung allograft acceptance. Other studies, such as tandem lung transplant and bone marrow transplant in select patients with primary immunodeficiency may provide additional lessons on how to potentially establish tolerance. However, tolerance in lung transplant is extremely rare, and further studies are needed to pursue this ultimate goal.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"404-408"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Telomeropathy: pretransplant and posttransplant considerations for clinicians.","authors":"John A Mackintosh","doi":"10.1097/MCP.0000000000001169","DOIUrl":"10.1097/MCP.0000000000001169","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the current understanding of telomere biology disorders (TBDs) in advanced lung disease, with particular focus on their implications for lung transplantation outcomes and management.</p><p><strong>Recent findings: </strong>Recent studies have revealed that TBDs are enriched in lung transplant populations, with many idiopathic pulmonary fibrosis transplant recipients having short telomeres and/or carrying variants in telomere-related genes. While survival outcomes remain debated, recipients with short telomeres consistently show increased susceptibility to cytopenias, cytomegalovirus (CMV) infection, and may require modified immunosuppression regimens. New evidence suggests potential protection against acute cellular rejection in some cases, and novel approaches using letermovir for CMV prophylaxis show promise in managing these complex patients.</p><p><strong>Summary: </strong>Management of lung transplant recipients with TBDs requires careful consideration of multiorgan manifestations and individualized management strategies. A multidisciplinary approach incorporating genetics, haematology, and hepatology expertise is increasingly essential for optimal outcomes in this unique population.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"366-373"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing lung transplantation through machine learning and artificial intelligence.","authors":"Lielle Ronen, Shaf Keshavjee, Andrew T Sage","doi":"10.1097/MCP.0000000000001168","DOIUrl":"10.1097/MCP.0000000000001168","url":null,"abstract":"<p><strong>Purpose of review: </strong>To explore the current applications of artificial intelligence and machine learning in lung transplantation, including outcome prediction, drug dosing, and the potential future uses and risks as the technology continues to evolve.</p><p><strong>Recent findings: </strong>While the use of artificial intelligence (AI) and machine learning (ML) in lung transplantation is relatively new, several groups have developed models to predict short-term outcomes, such as primary graft dysfunction and time-to-extubation, as well as long-term outcomes related to survival and chronic lung allograft dysfunction. Additionally, drug dosing models for Tacrolimus levels have been designed, demonstrating proof of concept for modelling treatment as a time-series problem.</p><p><strong>Summary: </strong>The integration of ML models with clinical decision-making has shown promise in improving post-transplant survival and optimizing donor lung utilization. As technology advances, the field will continue to evolve, with enhanced datasets supporting more sophisticated ML models, particularly through real-time monitoring of biological, biochemical, and physiological data.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"381-386"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ABC of transplant: ALAD, BLAD, and CLAD: definition and significance.","authors":"Geert M Verleden, Saskia Bos","doi":"10.1097/MCP.0000000000001170","DOIUrl":"10.1097/MCP.0000000000001170","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic lung allograft dysfunction (CLAD) is a recognized complication after lung transplantation, with a clear definition, although some pitfalls in phenotyping still exist. Recently, new terminologies, such as acute lung allograft dysfunction (ALAD) and baseline lung allograft dysfunction (BLAD) were introduced, but their definitions and real significance are not yet fully established.</p><p><strong>Recent findings: </strong>Based on the existing literature and ongoing discussions within two expert groups of the Advanced Lung Failure & Transplantation Interdisciplinary Network (ALFTx IDN) of the International Society for Heart and Lung Transplantation (ISHLT), we will describe current definitions, prevalence and outcome of these rather new entities, keeping in mind that a lot of uncertainties still exist.</p><p><strong>Summary: </strong>ALAD and BLAD will be defined, and the currently accepted outcome of these conditions will be summarized. Existing pitfalls in the phenotyping of CLAD will also be discussed.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"397-403"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emerging therapies and current standards in pulmonary carcinoid management.","authors":"Danielle I Aronowitz, Kevin Hyman","doi":"10.1097/MCP.0000000000001173","DOIUrl":"10.1097/MCP.0000000000001173","url":null,"abstract":"<p><strong>Purpose of review: </strong>Relative to other lung tumors, pulmonary carcinoid tumors are rare and have unique histopathological and clinical features. The purpose of this review is to summarize the presentation and management of pulmonary carcinoid tumors, with a particular focus on recent clinical trials in the management of advanced and metastatic disease.</p><p><strong>Recent findings: </strong>Surgical resection remains a central tenet in the management of pulmonary carcinoid tumors that are localized and even those that have locoregional spread. However, in recent years, the treatment of pulmonary carcinoid has expanded to include several systemic hormonal and cytotoxic therapies as well as radiation and endobronchial strategies. The decision to initiate any of these therapies as either primary or adjuvant treatment after resection depends upon several factors including tumor stage, disease burden, patient's functional status, and whether they will tolerate surgery.</p><p><strong>Summary: </strong>The treatment of pulmonary carcinoid tumors has expanded beyond just surgical resection. Novel regimens of systemic hormonal and cytotoxic therapies as well as radiation and endobronchial intervention should be customized for each patient by a multidisciplinary team of surgeons, medical and radiation oncologists, pulmonologists, and pathologists.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"321-325"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Considering candidates: modifiable and nonmodifiable risk factors for lung transplantation.","authors":"Julia A Maheshwari, Lorriana E Leard","doi":"10.1097/MCP.0000000000001174","DOIUrl":"10.1097/MCP.0000000000001174","url":null,"abstract":"<p><strong>Purpose of review: </strong>Evaluation of a candidate's risk profile for lung transplant includes understanding which patient factors can be addressed to minimize transplant risk. Some risk factors can be modified, while others cannot. This review explores current understanding of modifiable and nonmodifiable risk factors for lung transplantation.</p><p><strong>Recent findings: </strong>Several risk factors for lung transplant can be resolved entirely, thereby minimizing a candidate's transplant risk. Some features cannot be eliminated, though can be optimized to minimize risk. Others cannot be altered and inherently bring risk to transplant, while a subset of nonmodifiable risk factors are considered absolute barriers to transplant.</p><p><strong>Summary: </strong>Robust research and novel therapies have led to increased ability to modify certain risk factors and thus decrease lung transplant risk. Further studies are needed to better understand how to estimate risk profiles when assessing candidacy and timing for lung transplant.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"359-365"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhishek Sarkar, Shaikh Muhammad Noor Husnain, Kassem Harris
{"title":"A comprehensive review of benign tumors in the lung.","authors":"Abhishek Sarkar, Shaikh Muhammad Noor Husnain, Kassem Harris","doi":"10.1097/MCP.0000000000001178","DOIUrl":"10.1097/MCP.0000000000001178","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to provide clinicians a comprehensive overview of the epidemiology, clinical symptoms, radiological features, pathological features, and management recommendations for the vast majority of benign lung tumors. Benign lung tumors are very rare with incidence ranging from 1 in 1000 to 1 in 1 million. Despite not being malignant, certain benign tumors carry significant morbidity and mortality along with diagnostic challenges.</p><p><strong>Recent findings: </strong>Advancements in genomic sequencing have led to discovery of mutations in particular benign lung tumors. Improved genotyping have aided the diagnosis of certain tumors and the identification of lung lesions with malignant transformation potential. Genomic understanding has also led to targeted therapy for tumors with significant morbidity.</p><p><strong>Summary: </strong>Despite radiographic and pathologic advances in understanding benign lung tumors, the paucity of cases continues to impact management recommendations and early detection. Global collaborative initiatives in compiling and analyzing cases are essential for stronger evidence based management recommendations.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"311-320"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence applications for the diagnosis of pulmonary nodules.","authors":"David E Ost","doi":"10.1097/MCP.0000000000001179","DOIUrl":"10.1097/MCP.0000000000001179","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review evaluates the role of artificial intelligence (AI) in diagnosing solitary pulmonary nodules (SPNs), focusing on clinical applications and limitations in pulmonary medicine. It explores AI's utility in imaging and blood/tissue-based diagnostics, emphasizing practical challenges over technical details of deep learning methods.</p><p><strong>Recent findings: </strong>AI enhances computed tomography (CT)-based computer-aided diagnosis (CAD) through steps like nodule detection, false positive reduction, segmentation, and classification, leveraging convolutional neural networks and machine learning. Segmentation achieves Dice similarity coefficients of 0.70-0.92, while malignancy classification yields areas under the curve of 0.86-0.97. AI-driven blood tests, incorporating RNA sequencing and clinical data, report AUCs up to 0.907 for distinguishing benign from malignant nodules. However, most models lack prospective, multiinstitutional validation, risking overfitting and limited generalizability. The \"black box\" nature of AI, coupled with overlapping inputs (e.g., nodule size, smoking history) with physician assessments, complicates integration into clinical workflows and precludes standard Bayesian analysis.</p><p><strong>Summary: </strong>AI shows promise for SPN diagnosis but requires rigorous validation in diverse populations and better clinician training for effective use. Rather than replacing judgment, AI should serve as a second opinion, with its reported performance metrics understood as study-specific, not directly applicable at the bedside due to double-counting issues.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"344-351"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The role of artificial intelligence in the diagnosis, imaging, and treatment of thoracic empyema.","authors":"Adam Zumla, Rizwan Ahmed, Kunal Bakhri","doi":"10.1097/MCP.0000000000001150","DOIUrl":"10.1097/MCP.0000000000001150","url":null,"abstract":"<p><strong>Purpose of review: </strong>The management of thoracic empyema is often complicated by diagnostic delays, recurrence, treatment failures and infections with antibiotic resistant bacteria. The emergence of artificial intelligence (AI) in healthcare, particularly in clinical decision support, imaging, and diagnostic microbiology raises great expectations in addressing these challenges.</p><p><strong>Recent findings: </strong>Machine learning (ML) and AI models have been applied to CT scans and chest X-rays to identify and classify pleural effusions and empyema with greater accuracy. AI-based analyses can identify complex imaging features that are often missed by the human eye, improving diagnostic precision. AI-driven decision-support algorithms could reduce time to diagnosis, improve antibiotic stewardship, and enhance more precise and less invasive surgical therapy, significantly improving clinical outcomes and reducing inpatient hospital stays.</p><p><strong>Summary: </strong>ML and AI can analyse large datasets and recognize complex patterns and thus have the potential to enhance diagnostic accuracy, preop planning for thoracic surgery, and optimize surgical treatment strategies, antibiotic therapy, antibiotic stewardship, monitoring complications, and long-term patient management outcomes.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"237-242"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}