STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by mutations in TMEM173 gene encoding STING (stimulator of interferon genes). It typically presents in infancy and is mainly characterized by interstitial lung disease, skin rash, and systemic inflammation. This report presents the case of adult-onset SAVI:A 28-year-old male patient was admitted with recurrent episode of cough, expectoration, chest tightness with shortness of breath and erythematous rashes on the extremities, chest, and back.His CT revealed bilateral diffuse fine reticular opacities and irregular reticular shadows, with focal areas of honeycombing. Further inquiry into the family history revealed that the patient's mother had been diagnosed with interstitial lung disease (ILD).Thus, a genetic etiology should be highly suspected.Later, whole-exome sequencing identified a heterozygous mutation in the STING1 gene: c.842G>A (p.R281Q), establishing the diagnosis of SAVI. The patient was subsequently referred to a tertiary care hospital for specialized management. During one year of follow-up, the patient underwent lung transplantation in August 2025 and had since received long-term immunosuppressive therapy for rejection prophylaxis. Cough and expectoration improved markedly, although exertional dyspnea persisted; the cutaneous rash had resolved completely.

Lung transplantation is conspicuously resource intensive, yet the carbon footprint of solid organ transplantation, and lung transplantation in particular, remains relatively unmapped. Moreover, there is growing evidence that climate change adversely affects lung transplant recipients, directly and indirectly. This review explores opportunities to integrate sustainable practices across the lung transplantation pathway, with the dual aims of reducing environmental impact and reducing recipient morbidity and mortality. Published literature outlines mitigation strategies to reduce the drivers of climate change, and adaptation strategies to modify the hazardous effects of the climate crisis on healthcare services. Opportunities to create "green chains" of transplant care start with appropriate recipient and donor selection, with both elements optimised to maximise operative success and avoid donor organ discard. The peri-operative phase offers scope for decarbonisation via the reduction of anaesthetic gas emissions, green procurement, and waste reduction. In the post-transplant phase, enhanced recovery after surgery (ERAS) programmes feed into longer term surveillance and care delivery, with increasing opportunities for telemedicine and noninvasive allograft monitoring, to reduce travel-related emissions. The co-ordinated adoption of low-carbon, sustainable practices within lung transplantation offers a meaningful opportunity to reduce environmental harm, enhance healthcare infrastructure and workforce resilience, and improve patient outcomes in a patient cohort vulnerable to climate change. Lessons can be drawn from the global surgery movement; however, it remains the responsibility of transplant practitioners to foster a culture of environmental advocacy and to implement systematic measurement and targets for climate change and health indicators.

Donor-Specific Antibody Formation and Kinetics After Lung Transplantation - A ScanCLAD Trial Substudy

Long-term outcomes after adult lung transplantation remain limited by rejection, infection, and toxicity related to immunosuppressive therapy. Conventional protocol-based immunosuppression fails to account for substantial interindividual variability in immune risk, drug metabolism, and susceptibility to complications. This review is timely as emerging biomarkers and digital tools promise to shift lung transplantation toward individualized immune management. Recent studies highlight the role of Torque Teno virus (TTV) load as a surrogate marker of net immunosuppression, donor-derived cell-free DNA (dd-cfDNA) as a sensitive indicator of graft injury, and tissue-bound donor-specific antibodies as markers of localized alloimmune activity. Pharmacogenomic profiling and immunomodulatory strategies such as extracorporeal photopheresis further enable risk-adapted therapy. Integration of blood and BAL-based biomarkers allows earlier detection of subclinical rejection and infection risk. Precision immunosuppression in lung transplantation is transitioning from concept to early clinical implementation. Combining clinical risk stratification with immune and graft-injury biomarkers may allow safer immunosuppression minimization and improved long-term outcomes, although prospective validation is still required.

Lung transplant remains the ultimate life-saving therapy for people with progressive end-stage lung disease. It is important to highlight the evolution of the field in the United States, as its development has had varying impacts on the different lung transplant candidate groups. This review seeks to synthesize current evidence on the evolution of transplantation across various patient groups, reflecting advances in medical therapies, the implementation of the new composite allocation score (CAS) and trends in lung transplant candidate groups over the years. The proportion of waitlisted candidate with chronic obstructive pulmonary disease (COPD, group A) and cystic fibrosis (group C) has declined, reflecting the impact of novel therapeutics and advanced procedural interventions. In contrast, restrictive lung disease patients (group D) now account for most lung transplant recipients, which is likely reflective of our increased use of extracorporeal membrane oxygen (ECMO) for bridging and transplant centers expanded eligibility. Pulmonary hypertension patients (group B) continue to face high waitlist mortality despite the change to the new allocation scoring system. Advancements in medical therapies and the new composite allocation scoring system has altered both the timing and outcomes for various transplant candidate groups. It is important that we continue to study these findings to optimize patient outcomes and organ allocation.

Lung transplantation (LTx) is performed in approximately 4500 patients worldwide each year. Postoperatively, patients are at high risk of muscle catabolism due to Intensive Care Unit (ICU)-acquired weakness, potentially compromising functional recovery. While post-LTx rehabilitation is usually initiated after hospital discharge, the feasibility and safety of early mobilization during the ICU stay remain unclear. This scoping review aimed to synthesize available evidence on the feasibility, safety, and outcomes of early mobilization initiated in the ICU following LTx. We conducted a scoping review with comprehensive searches in MEDLINE (via PubMed), Embase, PEDro, Web of Science, CINAHL, Scopus, Cochrane CENTRAL, and PROSPERO. Study selection, data extraction, and analysis were performed independently by two reviewers. The search identified 3219 records, of which 32 sources met inclusion criteria, including 17 original studies, three conference abstracts, four registered protocols, and eight narrative reviews. Despite marked heterogeneity in study designs, interventions, and outcomes, early mobilization was consistently reported as feasible and safe, with initiation possible within the first 24h of ICU stay. Interventions were generally multimodal, progressive, and individualized. Adverse events were infrequently reported. Early mobilization during the ICU stay following LTx appears feasible and safe, although the evidence is limited by the small number of studies and the predominance of low-level designs. Based on the available literature, we propose a preliminary mobilization framework tailored to this population. Further high-quality studies are required to confirm these findings and to evaluate clinical benefits. Open Science Framework https://osf.io/nhr3e.

Extracorporeal Membrane Oxygenation as a Bridge to Heart and Combined Heart - Lung Transplantation

Lung transplantation remains limited by donor organ scarcity. This review summarizes recent strategies with the direct potential to expand lung availability, including 10°C hypothermic preservation, donation after circulatory death (DCD), ex vivo lung perfusion (EVLP), and expanded utilization of elderly donors. Clinical translation of 10°C static preservation has enabled prolonged storage, including preservation for up to 24 h without clear adverse short- or intermediate-term consequences, and the prospect of semi-elective transplantation. Contemporary evidence supports broader use of DCD lungs, particularly controlled DCD, with reassuring long-term outcomes despite small differences in early risk in some cohorts; uncontrolled DCD remains promising in highly organized EVLP-based programs, whereas thoracoabdominal normothermic regional perfusion requires further prospective evaluation. EVLP continues to increase utilization of marginal lungs, and the largest single-center series reported outcomes comparable to conventional transplantation. In parallel, carefully selected septuagenarian and even octo-/nonagenarian donors have demonstrated encouraging short- and long-term clinical outcomes. Donor shortage in lung transplantation can be mitigated by combining logistics-extending preservation strategies, broader donor pathways, advanced graft assessment, and careful expansion of donor acceptance criteria. Standardized, prospective, multicenter clinical trials are still frequently lacking and represent an area for future improvement.

Histologic Patterns of Antibody Mediated Rejection in Lung Transplant

dd-cfDNA Reflects Donor-Specific Antibody Strength and Class After Lung Transplant

Cystic fibrosis (CF) is a monogenic disorder leading to pulmonary disease, pancreatic insufficiency and cystic fibrosis-related diabetes (CFRD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are now being investigated in people with cystic fibrosis (pwCF) and CFRD. To date, their therapeutic potential has been almost exclusively studied in case reports or case series. These agents improved glycated haemoglobin (HbA1c) and continuous glucose monitoring (CGM) parameters. Benefits were also observed in weight reduction, particularly for subjects on cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy elexacaftor/tezacaftor/ivacaftor (ETI). However, discordant results have also been reported. Moreover, GLP-1RAs have improved pulmonary function, even following lung transplantation. Importantly, the dual glucagon-like peptide1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide has also yielded favourable outcomes. Finally, preliminary evidence suggests potential inhibition of bone resorption, pointing to a therapeutic perspective in cystic fibrosis-related bone disease (CFBD). However, potential adverse events should not be ignored. These include risk of acute pancreatitis, nausea/vomiting, nutritional depletion, bowel dysmotility and distal intestinal obstruction syndrome, as well as others. Adverse events should be addressed with caution, and dose adjustments may be useful. Large prospective multicentre studies are now required to validate these outcomes and to suggest implications for clinical practice.

Defining the Clinical Significance of First and Recurrent A1 Rejection After Lung Transplantation

Beyond the Lungs: Antibody-Mediated Rejection Presenting as Neuropsychiatric Syndrome After Lung Transplant

Routine Long-Term Use of Proton Pump Inhibitors is Widespread with Unknown Benefit in Clinical Outcomes After Lung Transplantation

Donor-Derived Cell-Free DNA (dd-cfDNA) May Be Discordant with Cellular Profiles in Bronchoalveolar Lavage Fluid (BALF) After Lung Transplantation (LT): A LAMBDA Study Analysis

Patient Perspectives on Clinical Trial Design in Lung Transplantation

Lung Transplantation in Recipients Aged 65 Years or Older: The Portuguese Experience

Glucagon-Like Peptide 1 Agonists in Lung Transplantation, a Mixed Bag

Assessing the Impact of Organ Procurement Organization on Short and Long-Term Survival After Lung Transplantation

A Single Center Case Series of Combined Liver and Lung Transplantation