What question did this study set out to answer?

This study aims to assess the effect of belumosudil on lung function in patients with chronic lung allograft dysfunction (CLAD) after lung transplantation.

May 20, 2026

C47-20 Real World Effectiveness of Belumosudil in Chronic Lung Allograft Dysfunction After Lung Transplantation

Key Points

This study aims to assess the effect of belumosudil on lung function in patients with chronic lung allograft dysfunction (CLAD) after lung transplantation.
Retrospective single-center study of lung transplant recipients with ISHLT-defined CLAD on belumosudil.
Spirometry measurements taken before and after therapy to assess FEV1 changes.
Wilcoxon signed-rank tests used to analyze changes in FEV1 (L and % predicted).
Among 30 CLAD patients, median FEV1 at diagnosis was 1.38 L (51.5% predicted), declining to 1.35 L (46.5% predicted) before treatment.
Median FEV1 change before belumosudil initiation was -0.080 L, and after initiation was -0.090 L, showing a trend towards stabilization.
Positive Wilcoxon Z statistics indicated a trend toward stabilization in FEV1 post-belumosudil, despite minimal median value changes.

Abstract

Abstract Rationale Chronic lung allograft dysfunction (CLAD) is the leading cause of morbidity and mortality after lung transplantation, defined by a persistent ≥20% decline in FEV1 with exclusion of reversible causes. Belumosudil, an oral selective ROCK2 inhibitor, targets immune dysregulation and fibrosis and has demonstrated clinical responses in chronic graft-versus-host disease (cGVHD). Its impact on CLAD progression in lung transplant recipients is unknown. Methods We performed a retrospective, single-center study of adult lung transplant recipients with CLAD initiated on belumosudil between January 2024 and June 2025. Inclusion required ISHLT-defined CLAD and spirometry before and after therapy. Pre-drug change in spirometry was calculated by the difference of FEV1 (L and %pred) taken ∼90 days pre drug and time of drug initiation. Post-drug change in spirometry was calculated by the difference between FEV1 (L and %pred) at time of drug initiation and at most recent spirometry. The primary outcome was change in FEV1 (L and % predicted) pre-versus post-belumosudil, analyzed using Wilcoxon signed-rank tests. Results Among 30 patients with CLAD stages 1-4 at enrollment, 46.7% were stage 1, 20.0% stage 2, 26.7% stage 3, and 6.7% stage 4. The cohort was 66.9 ± 9.5 years old at therapy initiation and 60% male. Transplant types included 43.3% left, 33.3% right, and 23.3% double. Median (IQR) FEV1 at time of CLAD diagnosis was 1.38 ± 1.0 L (51.5 ± 31% predicted), declining to 1.35 ± 0.94 L (46.5 ± 29% predicted) just prior to enrollment. Median FEV1 change prior to belumosudil initiation was −0.080 ± 0.18 L (−3.0 ± 8% predicted). Following belumosudil, the median change was (-0.090 ± 0.2 L; -3.0 ± 8.3% predicted). (FEV1 Z = + 1.81 FEV1 p = 0.070; FEV1 % predicted FEV1 Z = +1.95 p = 0.051) Despite lower median change following drug, the positive Wilcoxon Z Standardized statistic indicated positive FEV1 trend post drug. Median FEV1 change per day prior to belumosudil initiation was -0.7 ± 1.7 mL (-.0295 ± 0.07% predicted). Following belumosudil, the median change was -0.6±2.3 mL; -0.0265± 0.11% predicted). (FEV1 Z = +1.49 p = 0.136; Z = +1.60 FEV1 % predicted p = 0.108) Conclusion In this cohort of lung transplant recipients with CLAD, belumosudil was associated with a trend toward stabilization in decline FEV1 based on the full distribution of values despite minimal changes in median values. These findings suggest that ROCK2 inhibition may stabilize lung function decline in CLAD, supporting prospective evaluation of belumosudil as a therapeutic strategy. This abstract is funded by: None

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