Articular cartilage defects in the knee are common, and can result in pain, decreased function and decreased quality of life. Untreated defects are considered to be a risk factor for developing osteoarthritis, a progressive degenerative joint disease with minimal treatment options. To address these issues, various surgical procedures are available to treat articular cartilage defects in the knee. While these procedures overall have positive results, after surgery patients experience large and persistent deficits in quadriceps strength. A contributing factor to this post-surgical weakness is believed to be the extended post-operative non-weight bearing period, with full weight bearing not initiated until approximately 4 – 6 weeks after surgery. During this non-weight bearing period a minimal amount of demand is placed upon the muscle. Subsequently, the quadriceps muscle undergoes a large degree of atrophy with a significant decrease in muscle strength. Muscular strength deficits reduce the knee joint stability, also increasing the risk of osteoarthritis development. Interventions that can be used to facilitate quadriceps strength while protecting the articular cartilage repair are needed. Neuromuscular electrical stimulation (NMES) is an effective post-knee surgery rehabilitation technique to regain quadriceps musculature. In recent years manufactures have been developing knee sleeve garments integrated with NMES allowing for portability of the NMES treatment. The primary aim of this study was to evaluate the effectiveness of a 12-week home-based neuromuscular electrical stimulation treatment on post-surgical clinical outcomes (quadriceps strength, lower extremity function, and patient reported outcomes) after articular cartilage knee surgery. Patients were randomized between a standard of care home-treatment group and a NMES home-treatment group. Patients completed isometric quadriceps strength testing, the Y-balance test, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before surgery and at 3-months after surgery. The secondary aims of this study were to determine the most effective NMES parameters for post-surgical quadriceps strength; and to develop a framework to identify factors that may influence a patient’s adherence to a prescribed therapy program. From our results we can make several conclusions. First, we found only a small number of studies utilize similar parameters for post-surgical quadriceps strength treatments. The majority of the parameters reported in the literature were highly variable between studies. Second, clinicians can utilize the expanded Health Belief Model to identify situational and personal factors unique to a patient that may impact adherence to a prescribed treatment. Clinicians can then implement the proposed interventional strategies to address the identified situational and personal factors. Finally, there was no difference in quadriceps strength, lower extremity function, or self-reported scores at 3-month between a home-based NMES treatment and a standard of care home-based treatment. Patients’ adherence to the treatment protocols may have been a major factor contributing to these results. Utilizing a model, such as the proposed expanded Health Belief Model, may assist clinicians in improving a patients’ adherence to future prescribed home-treatment programs.

La transplantation rénale reste le traitement de choix du stade terminal la maladie rénale chronique. Malgré la diminution très significative de l'incidence du rejet aigu à médiation cellulaire (ACR), la survie à long terme des greffons rénaux reste relativement stable probablement à cause de l'augmentation du rejet à médiation humorale. Dans cette thèse, nous avons exploré deux objectifs de l'analyse moléculaire au cours de la transplantation rénale dont les biomarqueurs font partie intégrante : la prédiction de l'épisode de rejet aigu avant même l'apparition des lésions histologiques et l'amélioration de nos connaissances sur la physiopathologie des mécanismes immunologiques afin de pouvoir adapter le mieux possible le traitement immunosuppresseur.Dans un premier travail clinique préliminaire à la recherche de biomarqueurs, nous avons analysé dans une cohorte rétrospective de 87 patients, les facteurs de risque indépendants de perte du greffon rénal après un épisode de rejet aigu à médiation humorale (AMR) C4d positif. L'analyse par régression de Cox a retrouvé deux deux facteurs de risque : le niveau initial de dégradation de la fonction du greffon rénal et la présence concomittante d'un rejet aigu à médiation cellulaire. Dans un deuxième travail, nous avons exploré la possibilité d'utiliser des biomarqueurs non invasifs plutôt que la biopsie du greffon rénal chez des patients avec dysfonction aigue du greffon, situation à risque de dysfonction chronqiue du greffon rénal. Nous avons mesuré le niveau d'expression urinaire de 26 ARN messagers préselectionnés chez 84 transplantés rénaux avec dysfonction aigue du greffon, 32 nécrose tubulaire aigue, 26 ACR et 26 AMR Puis par une analyse discriminante suivie d'une validation croisée, nous avons découvert et validé une combinaison linéaire de six ARNm CD3e, CD105, TLR4, CD14, le facteur B du complément et la vimentine différentiant efficacement le rejet aigu de la nécrose tubulaire aigue. Cette combinaison linéaire permet d'épargner un nombre significatif de biopsies du greffon non indispensables. Puis, par la même technique, nous avons découvert et validé une nouvelle combinaison linéaire d'ARNm CD3e, CD105, CD14, CD46, et l'ARNr 18S pouvant différentier efficacement l'ACR de l'AMR. A l'avenir ces signatures pourraient diminuer le recours à la réalisation d'une biopsie du greffon puis une aide au diagnostic précoce des épisodes de rejets aigus. Dans un troisième travail, nous avons analysé le phénotype lymphocytaire B de patients transplantés rénaux traités par anticalcineurines (CNI) (N=12) et belatacept (N=13), immunosuppresseur inhibiteur de la costimulation. Les patients traités par belatacept ont une meilleure survie à long terme que ceux traités par CNI. Chez les patients traités par belatacept, nous avons retrouvé un phénotype B particulier avec une augmentation significative des lymphocytes B et des lymphocytes B transitionnels CD19+ CD24hi CD38hi et CD19+ IgDhi CD38hi CD27 potentiellement régulateurs par rapport aux patients traités par CNI. Le niveau d'expression de l'ARNm de BAFF et de BAFF-R dans les PBMCs était significativement plus bas chez les patients traités par belatacept. Nos résultats pourraient expliquer en partie les meileurs résultats cliniques observés chez les patients traités par belatacept après transplantation rénale.En conclusion, au cours de cette thèse, nous avons évalué l'intérêt des biomarqueurs, dans deux domaines, la recherche de facteurs pronostiques et diagnostiques du rejet aigu à médiation humorale par l'analyse d'une cohorte clinique et du transcriptome urinaire d'une partie de cette cohorte et l'analyse des mécanismes physiopathologiques au cours de la tolérance induite par le belatacept. Nos résultats méritent d'être confirmés dans des cohortes indépendantes de patients avant leur utilisation en pratique clinique courante et l'évaluation de leur impact sur la survie des greffons rénaux. / Kidney transplantation remains the best treatment in advanced chronic kidney disease. Acute T-cell mediated rejection (ACR) decreased significantly but long-term kidney allograft survival did not increase significantly these last ten years. Antibody-mediated rejection is probably the main part of the problem. In this work, we explored two ways of the molecular analysis of kidney transplant, including biomarkers: prediction of rejection and study of the mechanisms of immunosuppressiv agents within kidney transplantation.The first one, a preliminary clinical work, identified in a retrospective cohort of 87 for-cause biopsies with C4d positive acute antibody-mediated rejection (AMR) independant risk factors for renal allograft failure after the AMR. The Cox regression analysis identified that concurrent ACR and estimated glomerular filtration rate are independent risk factors for allograft loss. The second one explored how noninvasive tests to differentiate the basis for acute dysfunction of the kidney allograft could replace invasive allograft biopsy. We measured absolute levels of 26 prespecified mRNAs in urine samples collected from kidney graft recipients at the time of for-cause biopsy for acute allograft dysfunction. We profiled 52 urine samples from 52 patients with biopsy specimens indicating acute rejection (26 ACR and 26 AMR) and 32 urine samples from 32 patients with acute tubular injury (ATI) without acute rejection. A stepwise quadratic discriminant analysis ofmRNA measures identified a linear combination ofmRNAs for CD3e, CD105, TLR4, CD14, complement factor B, and vimentin that distinguishes acute rejection from ATI; 10-fold cross-validation of the six-gene signature yielded an estimate of the area under the curve of 0.92 (95% CI, 0.86 to 0.98). In a decision analysis, the sixgene signature yielded the highest net benefit across a range of reasonable threshold probabilities for biopsy. Next, among patients diagnosed with acute rejection, a similar statistical approach identified a linear combination ofmRNAs for CD3e, CD105, CD14, CD46, and 18S rRNA that distinguishes ACR from AMR, with a cross-validated estimate of the area under the curve of 0.81 (95% CI, 0.68 to 0.93). Incorporation of these urinary cell mRNA signatures in clinical decisions may reduce the number of biopsies in patients with acute dysfunction of the kidney allograft. In the third one, we analyzed B cell phenotype in kidney transplant recipients treated with the costimulation blocker belatacept and compared them to recipients treated with calcineurin inhibitors (CNI). Phase III clinical studies have shown that patients kidney treated belatacept exhibited a better renal allograft function and lower donor-specific anti-HLA immunization when compared to recipients treated with CNI. Thirteen patients treated with belatacept and 12 with CNI were phenotyped. In belatacept group, the frequency and absolute number of transitional B cells as defined by both phenotypes: CD19+ CD24hi CD38hi and CD19+ IgDhi CD38hi CD27-, as well as naïve B cells were significantly higher compared with CNI group. B cell activating factor (BAFF) and BAFF receptor mRNA levels were significantly lower in belatacept group than in CNI group. These results show for the first time that belatacept influences B cell compartment by favoring the occurrence of transitional B cells with potential regulatory properties, as described in operational tolerant patients. This role may explain the lower alloimmunization rate observed in belatacept-treated patients.To conclude, we evaluated biomarkers analysis within two ways, acute antibody-mediated rejection prognosis and diagnosis with a clinical cohort and urinary transcriptomic analysis and mechanisms of action of belatacept induced tolerance. Our results need to be validated in an independent cohort before to be integrated in clinical decision and evaluation of their impact on long term graft survival.

The use of allograft bone is effective in the treatment of large bone loss following tumour removal or surgery. However, it is not osteogenic due to a lack of viable osteogenic cells and the remaining marrow material is potentially harmful to the recipient. Sterilisation techniques, such as gamma irradiation, are routinely used to improve the safety of these grafts; however this fails to remove the immunogenic material and may diminish the bones innate properties. Thus, wash techniques are being developed to remove the deleterious marrow, whilst retaining the native properties of the bone so that through tissue engineering, pre-osteogenic cells may be added to aid osseointegration. To this end, this study utilised a novel wash process (developed by the National Health Service Blood and Transplant Tissue services (NHSBT)) on whole human femoral heads, to assess the resulting material’s suitability as a biological scaffold for bone tissue engineering (BTE). Following the wash process, marrow removal efficiency was analysed by biochemical testing and histological assessment, and biocompatibility of fresh-frozen and washed human bone was assessed using extract cytotoxicity assays with BM-MSCs. The results showed a marrow removal efficiency of 99.5%, leaving a material with only 16.7 ng DNA/100mg of dry material, and which histologically displayed minimal cellular content demonstrating that this was an efficient wash process producing an acellular biological scaffold material (<50ng DNA/100mg bone). Extract cytotoxicity testing indicated the material was biocompatible. Uniaxial compression to failure was performed on 1cm3 cubes using bone samples from mirrored location of bilaterally halved femoral heads, with one half washed, whilst the other was fresh-frozen. A random orientated “clinical” model was also utilised, with samples processed as fresh-frozen, washed and irradiated for comparative assessment. There was no significant change in the mechanical strength of the washed material compared to fresh-frozen samples or between sterilisation types, suggesting the washed bone was mechanically comparable to existing bone allograft stock. BM-MSCs from both young (≤50 years) and old donors (≥70 years) were seeded on washed bone cubes from young and old donors, and cultured in standard or osteogenic media. Samples were analysed at 0, 14 and 28 day timepoints for cell viability, osteogenic gene expression, alkaline phosphatase activity and histological analysis. Results indicated significant fold increases in cell metabolism at day 14 and 28, in both medium types compared to day 0 (p≤0.001). QRT-PCR data showed increased expression of osteogenic markers RUNX2 (p≤0.001), osteopontin (p≤0.001) and osteocalcin (p≤0.001) in both standard and osteogenic media with significantly higher RUNX2 and osteocalcin in osteogenic medium samples at day 28. Expression of osteogenic genes was significantly higher in young donor cells seeded on the washed bone compared to old donor cells, as was expression in BM-MSCs cultured on old donor bone compared to young bone. This implies that the washed bone was able to induce osteogenic differentiation in BM-MSCs, that young donor cells were better able to differentiate than old, and that old donor bone was better able to induce osteogenic activity. Additionally, patient-matched BM-MSCs and ASCs, and BM-MSCs and BM-MNCs were seeded onto washed bone cubes and cultured for 28 days in standard or osteogenic media, with gene expression and metabolic activity assessed. The washed bone was able to induce osteogenic differentiation of ASCs. Moreover, BM-MNCs when cultured on washed bone also expressed osteogenic genes, indicative of osteogenic differentiation. These results indicate the efficacy of a novel wash process in producing a biological acellular scaffold suitable for bone tissue engineering. Interestingly, data also suggests that the age of the cell donor and bone donor may effect osteogenic differentiation of seeded cells which has significant implications clinically.

No description available.

Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival. Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels 10mg/dL or (iii) international normalized ratio (INR) 1.6 on postoperative day 7. Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly (P = 0.092; log rank-test = 2.87), graft survival was significantly higher in non-EAD patients (P = 0.008; log rank-test = 7.13). Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors (Bilirubin HR = 1.71 [1.34, 2.16]; INR HR = 2.69 [0.51, 14.31]), in contrast to AST (HR = 0.91 [0.75, 1.10]). Similar results were achieved for graft loss estimation. A comparison with the Model for Early Allograft Function (MEAF) and the Liver Graft Assessment Following Transplantation (L-GrAFT) score identified a superior discrimination potential but lower specificity. Conclusion: Contrarily to AST, bilirubin and INR have strong predictive capacity for patient and graft survival. This fits well with the understanding, that bile duct injury and deprivation of synthetic function rather than hepatocyte injury are key factors in LT.

Background: Fresh osteochondral allograft (OCA) transplantation represents a biologic restoration technique as an alternative treatment option for larger osteochondral lesions of the talus (OLT). The purpose of this study was to evaluate midterm outcomes after OCA transplantation for the treatment of OLT. Methods: Nineteen patients (20 ankles) received partial unipolar OCA transplant for symptomatic OLT between January 1998 and October 2014. The mean age was 34.7 years, and 53% were male. The average graft size was 3.8 cm2. All patients had a minimum follow-up of 2 years. Outcomes included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), the Olerud-Molander Ankle Score (OMAS), and pain and satisfaction questionnaires. Failure of OCA was defined as conversion to arthrodesis or revision OCA transplantation. Results: Five of 20 ankles (25%) required further surgery, of which 3 (5%) were considered OCA failures (2 arthrodesis and 1 OCA revision). The mean time to failure was 3.5 (range, 0.9 to 6.7) years. Survivorship was 88.7% at 5 years and 81.3% at 10 years. The median follow-up of the 17 patients with grafts in situ was 9.7 years. The mean OMAS improved significantly from 40 points preoperatively to 71 points postoperatively (P < .05; range, 5 to 55). The mean postoperative AAOS-FAM core score was 81.5 ± 15 (range, 40.5 to 96.6). Fifteen of 17 patients responded to follow-up questions regarding their ankle; 14 patients reported less pain and better function, and 13 patients were satisfied with the results of the procedure. Conclusion: Our study of midterm results after OCA transplantations showed that this procedure was a reasonable treatment option for large OLT. Level of Evidence: Level IV, case series.

No description available.

Angiogenesis is an important process in maintaining normal physiology as well as in the pathology of many diseases. Angiogenesis based therapies have the potential to have a phenomenal impact on a diseases affecting more than one billion people worldwide, including all cancers, cardiovascular disease, blindness, arthritis, complications of AIDS, diabetes, Alzheimer's disease, and more than 70 other major health conditions affecting children and adults, in developed and developing nations. In this study, we investigate the role of Interleukin-19 (IL-19) and Allograft inflammatory factor-1 (AIF-1) in endothelial cells (EC) proliferation, migration, activation and angiogenic potential. IL-19 is a recently described member of the IL-10 family of anti-inflammatory cytokines. Nothing has been reported on the expression or mechanism(s) of IL-19 effects in endothelial cells. We have found that IL-19 is expressed in aortic endothelium, and can be induced in cultured EC by serum and inflammatory cytokine challenge. IL-19 is chemotactic for EC, and promotes cell spreading, migration, and wound healing. IL-19 pretreatment also enhances the migration of EC to Vascular endothelial growth factor (VEGF). IL-19 activates the signaling proteins STAT3, p44/42 MAPK, and Rac1, and induces expression of Matrix Metalloproteinase-2, which is obligate for EC migration. IL-19 promotes tube -like structure formation on Matrigel by Human Umbilical Vein EC (HUVEC), and promotes microvessel formation in mouse aortic ring assay. Taken together, these data suggest that IL-19 is a chemotactic cytokine for, and promotes the proliferation, migration, activation and angiogenic potential of endothelial cells. AIF-1 is a cytoplasmic, calcium-binding, inflammation-responsive scaffold protein that has been implicated in the regulation of inflammation. The expression and function of AIF-1 in EC is uncharacterized. AIF-1 expression co-localized with CD31-positive endothelial cells in neointima of inflamed human arteries, but not normal arteries. AIF-1 is detected at low levels in unstimulated EC, but expression can be increased in response to serum and soluble factors. Stable transfection of AIF-1 siRNA in EC reduced AIF-1 protein expression by 73%, and significantly reduced EC proliferation and migration. Rescue of AIF-1 expression restored both proliferation and migration of siRNA expressing ECs, and AIF-1 over expression enhanced both of these activities, suggesting a strong association between AIF-1 expression and EC activation. Activation of MAPK p44/42 and PAK1 was significantly reduced in siRNA ECs challenged with inflammatory stimuli. Reduction of AIF-1 expression did not decrease EC tube-like structure or microvessel formation from aortic rings, but over-expression of AIF-1 did significantly increase the number and complexity of these structures. These data indicate that AIF-1 expression plays an important role in proliferation, migration, signal transduction, and may have a role in angiogenesis. / Microbiology and Immunology

The underlying cause of all vascular proliferative diseases is injury-induced activation of vascular endothelium and vascular smooth muscle cells (VSMC). Activated VSMC proliferate, than migrate from the arterial media to the intima, contributing to neointima formation. Activated immune cells, vascular cells, and their endogenous regulators mediate this complex process. One integral regulator of VSMC activation is allograft inflammatory factor-1 (AIF-1). AIF-1 is a cytoplasmic scaffold protein, expressed constitutively in lymphoid cells and induced in VSMC by injury. Stable over expression of AIF-1 increases VSMC proliferation and migration in vitro, causes increased injury-induced neointima formation, and increases Rac1 and p38 MAP Kinase activity. Recent studies show a correlation between VSMC expression of AIF-1 and atherosclerosis development. We hypothesize that VSMC over expression of AIF-1 contributes to atherosclerosis development by increasing activity of inflammatory signaling molecules, and that inhibiting VSMC AIF-1 expression will decrease injury-induced neointima formation. Rat carotid arteries transfected with AIF-1 si RNA adenovirus after balloon angioplasty developed significantly less neointima compared to controls. AIF-1 si RNA transfected VSMC proliferated significantly less than AIF-1 or GFP transfected VSMC, while AIF-1 si RNA transfection did not attenuate AIF-1-mediated migration. p38 inhibition showed that AIF-1-mediated proliferation is dependent on p38 activation while AIF-1-mediated migration is not. AIF-1 transgenic mice fed a high fat diet showed significantly more atherosclerotic lesions than WT littermates. Boyden Chamber assays showed OxLDL treatment increases VSMC migration but does not effect AIF-1-mediated migration. Expression of migration and inflammatory responsive genes in AIF-1 and XGal transfected VSMC after OxLDL treatment at various time points were examined. MMP-2 and -9 expression did not change. ICAM-1 and VCAM-1 expression increased in both groups. AIF-1 VSMC showed significantly higher ICAM-1 expression at baseline and early time points and elevated, but not significantly higher VCAM-1 expression at early time points. Western blots showed increased activation of NF-kB in AIF-1 transfected VSMC at baseline and 30 minutes after OxLDL stimulation compared to XGal transfected VSMC. Expression of the scavenger receptor receptors CD36 and SRA(I) expression increased after lipid treatment in AIF-1 and XGal transfected groups. AIF-1 VSMC showed sustained expression of both receptors after 16 hours of treatment compared to XGal VSMC, which showed decreased expression at that time point. CXCL16/PSOX expression increased with treatment, but differences in expression patterns were not seen between cell groups. Analysis showed significantly more OxLDL was taken up by AIF-1 VSMC compared to XGal VSMC. These data show that AIF-1 expression in VSMC is tightly linked to the vascular response to injury and development of vascular disease. Although AIF-1-mediated migration is not p38 dependent, AIF-1 may contribute to increased VSMC migration in part by upregulating NF- kB downstream effectors through increased NF-kB activity. AIF-1 may also speed the progression of atherosclerosis by increasing scavenger receptor expression and thereby increasing OxLDL uptake and foam cell formation. Although more study is required to fully elucidate the molecular mechanisms leading to AIF-1 mediated VSMC activation, these data have further established AIF-1 as an integral regulator of the VSMC response to injury. / Molecular and Cellular Physiology

Contexte : La survie à long terme après la transplantation pulmonaire est compromise par le rejet chronique (chronic lung allograft dysfunction (CLAD)), une complication qui touche 50% des patients à 5 ans post-greffe. Le CLAD regroupe quatre phénotypes distincts caractérisés par une atteinte pulmonaire obstructive (Bronchiolitis obliterans syndrome (BOS)) ou restrictive (Restrictive allograft syndrome (RAS)), ou une combinaison des deux (phénotypes mixte et non défini). L’obésité est associée à une diminution de la fonction pulmonaire en raison de facteurs mécaniques, métaboliques et inflammatoires qui lui sont associés. Le gain de poids suite à la greffe pulmonaire est fréquent et parfois considérable, ce qui peut compromettre la fonction pulmonaire. Or, le lien entre le gain de poids post-greffe et la survenue des phénotypes du CLAD demeure inconnu. Objectifs : 1) Décrire les trajectoires pondérales post-greffe pulmonaire des patients ayant développé ou non l’un des quatre phénotypes du CLAD; 2) Déterminer si le statut pondéral à la greffe et la variation de poids et d’IMC après la greffe sont associés à la survenue des phénotypes du CLAD; 3) Examiner si les phénotypes du CLAD influencent la survie post-greffe. Méthodologie : Étude rétrospective des dossiers médicaux de patients ayant reçu une transplantation pulmonaire bilatérale au CHUM entre 2000 et 2020. En utilisant la classification de l’International Society for Heart and Lung Transplantation, les patients ont été classés parmi les cinq catégories suivantes : Absence ou présence de l’un des quatre phénotypes du CLAD. Résultats : Parmi les 579 patients inclus; 412 (71.1%) n’ont pas développé de CLAD, et 81 (14.0%), 20 (3.5%), 59 (10.2%) and 7 (1.2%) ont respectivement développé les phénotypes BOS, RAS, mixte et non-défini. Les trajectoires post-greffe de poids des patients qui développent une restriction pulmonaire (RAS, mixte et non-défini) se distinguent par des gains de poids plus importants. Une augmentation du poids (kg) (Hazard ratio [HR] : 1,04, IC 95% [1,01-1,08]; P = 0,008) et de l’IMC (kg/m2) (HR : 1,13, IC 95% [1,03-1,23]; P = 0,008) en post-greffe sont associés à une augmentation du risque de RAS. La survie post-greffe (années) est plus faible chez les patients ayant développé les phénotypes RAS (9,07 [IC 95% 7,43-10,70]), mixte (8,41 [IC 95% 6,56-10,25]) et non défini (9,99 [IC 95% 4,67-15,31]; p<0,001). Conclusion : Les liens entre le gain de poids post-greffe et la survenue des phénotypes restrictifs du CLAD doivent être clarifiées pour déterminer si une gestion optimale du poids préviendrait leur développement. / Background: Chronic lung allograft dysfunction (CLAD) is a common complication after lung transplant (LTx), affecting 50% of patients by five years post-LTx. It is associated with poor survival, limited to 1 to 5 years after CLAD diagnosis. Four CLAD clinical phenotypes have been defined: Bronchiolitis Obliterans Syndrome (BOS), Restrictive allograft syndrome (RAS), mixed and undefined phenotypes. Weight gain is commonly observed after LTx and may negatively impact lung function and post-LTx survival. Yet, the association between post-LTx weight gain and the development of CLAD and its phenotypes remains to be explored. Objectives: 1) To describe post-LTx weight trajectories of CLAD-free patients and patients who developed the various CLAD phenotypes; 2) To determine the associations between BMI at transplant, post-LTx variation of weight and BMI, and the risk of developing the various CLAD phenotypes and; 3) To examine whether the development of the CLAD phenotypes impacted post-LTx survival. Methods: This is a retrospective cohort study of patients who received a first bilateral LTx at the CHUM between 2000 and 2020. We extracted demographic, anthropometric, and clinical data from medical charts. Using the 2019 International Society for Heart and Lung Transplantation classification, patients were categorized among these five categories: CLAD-free or presence of one of the four CLAD phenotypes. Results: Our sample consisted of 579 patients; 412 (71.1%) remained CLAD-free, and 81 (14.0%), 20 (3.5%), 59 (10.2%), and 7 (1.2%) developed BOS, RAS, the mixed and the undefined phenotype, respectively. Weight trajectories showed that patients who developed restrictive CLAD (RAS, mixed and undefined) experienced weight gains of greater amplitude within the first five years post-LTx than CLAD-free patients and patients with BOS. An increase in weight (kg) (Hazard ratio [HR]: 1.04, 95% CI [1.01- 1.08]; P = 0.008) and BMI (kg/m2 ) (HR: 1.13, 95% CI [1.03-1.23]; P = 0.008) during post-LTx follow-up was associated with a greater risk of RAS. Worse survival (years) was seen in patients who developed the RAS (9.07 [95% CI 7.43-10.70]), mixed (8.41 [95% CI 6.56-10.25]), and undefined (9.99 [95% CI 4.67-15.31]; p<0.001) phenotypes. Conclusion: Future studies must clarify the associations between post-LTx weight gain and the onset of restrictive CLAD and whether it could be prevented with appropriate weight management strategies.