ISHLT Consensus Statement on Primary Graft Dysfunction in Lung Transplantation

Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation, occurring in 10–25% of recipients. This ISHLT consensus provides the diagnostic framework.

ISHLT expert consensus statement.

PGD definition: P/F ratio ≤300 within 72 hours of transplant with bilateral infiltrates on CXR, after excluding other causes (volume overload, rejection, pneumonia). Graded 0–3 based on P/F ratio. Grade 3 PGD (P/F <200) has 30-day mortality of 40–50%.

Know the PGD grading system (0–3) and timepoints (T0, T24, T48, T72). Grade 3 PGD = severe ARDS-like picture post-transplant. Management is supportive (lung-protective ventilation, prone positioning, ECMO as bridge). PGD is distinct from hyperacute rejection.

Consensus — not all recommendations are evidence-based. PGD pathophysiology is multifactorial.