{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:51:26Z","timestamp":1787237486847,"version":"build-2736575974"},"posted":{"date-parts":[[2026,4,23]]},"group-title":"Transplantation","reference-count":28,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,23]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We aimed to identify data-driven FEV1 trajectory phenotypes post-chronic lung allograft dysfunction (CLAD), relate these phenotypes to patient factors and future graft loss, and develop a classification approach for prospective patients.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We studied adult first lung recipients with probable CLAD from two prospective multicenter cohorts: CTOT-20 (n=206) and LTOG (n=1418). FEV1 trajectories over the first nine months post-CLAD were characterized using joint latent class mixed models, jointly modelling time-to-graft loss to account for informative censoring. Models were fit independently in both cohorts and also only among LTOG bilateral recipients. A classification and regression tree (CART) model was derived in LTOG bilateral recipients and applied to CTOT-20 bilateral recipients.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Four distinct early FEV1 trajectory classes were identified in CTOT-20, with large differences in nine-month graft loss (72\u00b73%, 31\u00b71%, 2\u00b72%, 0%). In LTOG, similar trajectory patterns were reproduced, with an additional class demonstrating early post-CLAD FEV1 improvement. Among bilateral recipients, trajectory classes showed a clear risk gradient, including a high-risk class with 100% graft loss and a low-risk class with no early graft loss. A CART model incorporating clinical and spirometric variables demonstrated good discrimination in LTOG bilateral recipients (multiclass AUC 0\u00b785) and consistent class assignment and trajectory patterns when applied to CTOT-20.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>We identified reproducible, clinically meaningful early post-CLAD FEV1 trajectory phenotypes with differential graft loss risk. These phenotypes and a pragmatic classification tool may support risk stratification, trial enrichment, and improved prognostication for patients and clinicians.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>National Institutes of Health, Cystic Fibrosis Foundation<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.04.22.26351501","type":"posted-content","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T22:45:14Z","timestamp":1776984314000},"source":"Crossref","is-referenced-by-count":1,"title":["Latent Class Analysis Identifies Pulmonary Function Trajectory Phenotypes in Lung Transplant Recipients with Chronic Allograft Dysfunction"],"prefix":"10.64898","author":[{"given":"Megan L.","family":"Neely","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA;"},{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Wojdyla","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwanhee","family":"Hong","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peijin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela R.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn","family":"Arroyo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Belperio","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Benvenuto","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Presbyterian Hospital and Vanderbilt Clinic, New York, NY, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Budev","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic, Cleveland, OH, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Combs","sequence":"additional","affiliation":[{"name":"University of Michigan Health, Ann Arbor, MI, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gundeep","family":"Dhillon","sequence":"additional","affiliation":[{"name":"Stanford Medicine Health Care, Stanford, CA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse Y.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel","family":"Kalman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tereza","family":"Martinu","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McDyer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Oyster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Pandya","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeeyon G.","family":"Rim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Roe","sequence":"additional","affiliation":[{"name":"Indiana University Health, Indianapolis, IN, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pali D.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University, Baltimore, MD, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P.","family":"Singer","sequence":"additional","affiliation":[{"name":"UC San Francisco, San Francisco, CA, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne G.","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie D.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA;"},{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Tsuang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic, Cleveland, OH, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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