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. 2026 Sep 18;39:16959. doi: 10.3389/ti.2026.16959

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Copyright © 2026 Bos, Hellemons, Dave, Engel, Holm, Morlacchi, Müller, Pavanello, Picard, Rossi, Saez-Gimenez, Gottlieb and Vos.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Flowchart summarizing prevention strategies for CLAD, including induction therapy/desensitization, maintenance immunosuppression (steroids, CNI with tacrolimus preferred, CCI with mycophenolate mofetil or azathioprine, mTORi), prevention RCTs guided by ISHLT consensus, additional immunomodulation with azithromycin, and expert opinion adjuncts such as adherence promotion, home monitoring, vaccination, antimicrobial prophylaxis, gastric reflux management, and avoiding inhaled toxins. Color- coded recommendations: green for in favor, yellow for neutral, blue for expert opinion only. — Recommendations for prevention of chronic lung allograft dysfunction. Overview of the different preventive strategies for chronic lung allograft dysfunction (CLAD) discussed in this Clinical Practice Guideline.