Toward pre-emptive CLAD care: fibroblast activation protein as a clinically actionable signal

Extract 9 months after lung transplant, the clinic visit often feels deceptively calm. Spirometry hovers near the patient's personal best, chest computed tomography is read as “post-operative change”, and the routine surveillance transbronchial biopsy (TBBx) comes back as “no acute cellular rejection”. A year later, we are counselling the same patient about chronic lung allograft dysfunction (CLAD) and discussing the possibility of re-transplantation. The uneasy truth is that our current clinical tools define CLAD after fibroblast-driven remodelling has already taken progressive and irreversible root.