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Les bronchectasies, ou dilatations des bronches, sont des anomalies anatomiques primitives ou secondaires. Leur compréhension est de plus en plus précise grâce à l'augmentation récente du nombre d'études portant sur leur physiopathologie, leur prise en charge et leurs étiologies. À l'heure actuelle, plusieurs pathologies sont associées aux bronchectasies, soit comme une complication de la pathologie initiale, soit à cause de l'existence d'un terrain clinique commun. L'étiologie d'une dilatation des bronches définit sa prise en charge extrarespiratoire, mais aussi le pronostic de l'atteinte pulmonaire et les traitements spécifiques à mettre en place. Il est donc crucial d'adresser un patient porteur de dilatations des bronches à un pneumologue, et de cerner le plus efficacement possible la pathologie causale. Nous établirons succinctement ici l'avancement actuel des connaissances concernant les bronchectasies, leurs étiologies et détaillerons les recommandations en cours pour les explorations initiales. [ABSTRACT FROM AUTHOR]

Background: The ISHLT guidelines recommend early referral to a lung transplantation (LTx) center for patients with interstitial lung disease (ILD) due to the unpredictable course. To our knowledge, no study has assessed the impact of forced vital capacity (FVC) reduction severity on LTx outcomes in ILD. This study aims to determine whether the severity of FVC reduction is associated with post-transplant outcomes in ILD., Methods and Results: Recipients from the French multicentric COLT cohort who underwent lung transplantation for ILD were included in this study. FVC was assessed to determine if the severity of its reduction is associated with post-transplant outcomes. 311 recipients were included in the study. FVC was identified as a significant risk factor for mortality at one year in multivariate analysis (p = 0.003). The ROC curve for FVC estimated the probability of death at one year with an area under the curve of 64 % (95 % confidence interval 57-71 %) and defined an optimal FVC threshold of 46 %. Recipients with an FVC ≤46 % were more likely to be listed as emergency cases, had lower FVC at one year, and exhibited reduced short- and long-term survival., Conclusions: The severity of pre-transplant FVC reduction is a risk factor for poorer post-transplant outcomes. The findings should stimulate discussion about benefits of LTx for patients with lower FVC. An FVC threshold of ≤46 % should be considered in discussions about lung transplantation indications, decisions regarding single lung transplantation, and the selection of smaller donor lungs. Respirologists managing patients with ILD should consider early referral to a LTx center., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 SPLF and Elsevier Masson SAS. All rights reserved.)

Objectives: SARS-CoV-2 mRNA vaccine reactogenicity has raised concerns regarding the risk of rejection in solid organ transplant recipients. We explored whether SOT recipients diagnosed with acute rejection had previously received a vaccine injection within a timeframe consistent with a causal link., Methods: We identified all SOT recipients with a diagnosis of acute rejection from 2020 to 2022 and who had previously received a SARS-CoV-2 vaccination, and analysed whether the delay between vaccination and rejection was constant., Results: In the 45 identified patients, median delay between the last SARS-CoV-2 vaccination and the rejection was 102 days [IQR 48-178]; the continuous distribution of this delay, with no identifiable time pattern, is not in favor of a role of vaccination in rejection., Conclusion: SARS-CoV-2 mRNA vaccination is unlikely to trigger rejection in SOT recipients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Antibody-mediated rejection (AMR) has been recognized as a significant cause of acute and chronic lung allograft dysfunction after lung transplantation. Some treatments, eculizumab, an anti-complement (C)5 component monoclonal antibody (Mab), seem to have a promising effect in the management of some patients with AMR. We present two patients with acute AMR after lung transplantation who received the anti-C5 Mab therapy. In both cases, we identified the presence of C4d deposition in the peritubular capillaries on trans-alveolar biopsies, which suggested activation of complement in AMR. Prior to eculizumab therapy, both patients had also received immunoadsorption, courses of intravenous immunoglobulins (IVIG) and rituximab. For the first patient, we have shown that eculizumab can serve as an effective bridge to re-transplantation. For the second patient, we observed the absence of clinical and biological efficacy, and without a clear therapeutic efficacy the therapy with eculizumab had been discontinued after two months., Competing Interests: Declaration of competing interest The authors had nothing to declare., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Standard immunosuppressive therapy for lung transplant recipients combines a calcineurin inhibitor, an antimetabolite, and corticosteroids. In an observational, retrospective, monocentric study, we sought to compare the development of chronic lung allograft dysfunction (CLAD) between 37 patients who received this standard therapy (triple-therapy group) and 59 patients who received the mammalian target of rapamycin (mTOR) inhibitor everolimus in addition to the standard therapy (quadruple-therapy group). In the quadruple-therapy group, the time elapsed from transplantation to everolimus introduction (median [25th-75th percentile]) was 12 [7-25] months. In 46/59 cases, the indication for everolimus introduction was renal function sparing. Median follow-up durations were 36 [20-62] months and 84 [52-123] months in the triple-therapy and quadruple-therapy groups, respectively (p = 0.004). The incidence of CLAD was lower in patients receiving everolimus than in those who did not with an adjusted odds ratio of 0.303 [0.118-0.775]. In addition, the median time from transplantation to CLAD was longer in patients receiving quadruple therapy comprising everolimus than in those who did not (63 [30-92] vs. 29 [12-44] months; p = 0.025). This suggests that the addition of everolimus to a standard triple could result in a lower incidence of CLAD in lung transplant recipients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Circulating extracellular vesicles (EVs) have shown promising results as noninvasive biomarkers for predicting disease outcomes in solid organ transplantation. Because in situ graft cell expression of the tolerogenic molecule HLA-G is associated with acceptance after lung transplantation (LTx), we hypothesized that plasma EV-bound HLA-G (HLA-GEV) levels could predict chronic lung allograft dysfunction (CLAD) development., Methods: We analyzed 78 LTx recipients from the Cohort-for-Lung-Transplantation cohort, all in a stable (STA) state within the first year post-LTx. At 3 y, 41 patients remained STA, and 37 had CLAD (bronchiolitis obliterans syndrome, BOS, [n = 32] or restrictive allograft syndrome [n = 5]). HLA-GEV plasma levels were measured at month 6 (M6) and M12 in 78 patients. CLAD occurrence and graft failure at 3 y post-LTx were assessed according to early HLA-GEV plasma levels., Results: In patients with subsequent BOS, (1) HLA-GEV levels at M12 were significantly lower than those in STA patients (P = 0.013) and (2) also significantly lower than their previous levels at M6 (P = 0.04).A lower incidence of CLAD and BOS and higher graft survival at 3 y were observed in patients with high HLA-GEV plasma levels at M12 (high versus low HLA-GEVs patients [cutoff 21.3 ng/mL]: freedom from CLAD, P = 0.002; freedom from BOS, P < 0.001; and graft survival, P = 0.04, [log-rank]). Furthermore, in multivariate analyses, low HLA-GEV levels at M12 were independently associated with a subsequent risk of CLAD, BOS, and graft failure at 3 y (P = 0.015, P = 0.036, and P = 0.026, respectively [Cox models])., Conclusions: This exploratory study suggests the potential of EV-bound HLA-G plasma levels as a liquid biopsy in predicting CLAD/BOS onset and subsequent graft failure., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)