Guiding light: new European guidelines on CLAD prevention and treatment

A Forum discussing: 1 2 European society for organ transplantation clinical practice guideline on prevention and 3 treatment of chronic lung allograft dysfunction 4 5 Bos, S. et al. Transpl. Int. 39, 16959 (2026). has also now shown that extracorporeal photopheresis (ECP) may prevent CLAD, in addition to 29 potentially lowering rates of rejection and infection as well. 7 These works build on a previous 30 successful Belgian clinical trial showing that azithromycin prophylaxis can reduce CLAD risk. 8 Despite these advances though, the evidence for CLAD therapeutics remains mixed or entirely 33 lacking, and this can result in heterogeneity in the clinical approach. 9,10 CLAD is a universally 34 feared complication, particularly in its rapidly progressive forms, and clinicians faced with an ailing 35 patient and armed with limited evidence do not tend to stand by. The interventions clinicians 36 impose are well-intentioned and may in some cases be beneficial but can set the stage for patient-