Factors influencing long-term outcomes in lung transplantation: effective monitoring and comprehensive intervention

Purpose of review Achieving long-term survival after lung transplantation remains a major challenge. Outcome determinants have expanded beyond pathophysiology to include quality of life and patient-reported outcomes. This review summarizes key prognostic factors associated with outcomes and suggests integrated strategies to improve them. Recent findings The primary determinants of long-term survival are chronic lung allograft dysfunction (CLAD), infection, and malignancy. Various agents have been investigated for preventing and treating CLAD. Beyond these, managing comorbidities such as renal failure, metabolic disorders, and gastrointestinal dysfunction is crucial. Furthermore, patient-reported outcomes involving both physical and psychosocial aspects (e.g., frailty and sleep disturbance) have emerged as vital prognostic markers. To manage these multifaceted risks, real-time data pipelines (e.g., the Quality in Lung Transplant Initiative) and remote tools including home spirometry facilitate early detection of graft dysfunction. Multidisciplinary interventions, including rehabilitation, adherence support, and artificial intelligence-driven technologies, have shown promise in improving outcomes. Summary Improving long-term outcomes in lung transplantation requires a comprehensive approach that extends beyond traditional CLAD management. Structured, multicomponent programs integrating data-driven surveillance with multidisciplinary care provide a robust model for early detection and intervention for graft failure and comorbidities, ultimately prolonging survival and quality of life.