Report of the ISHLT Working Group on Primary Lung Graft Dysfunction

Published 1 October 2005

JHLT October 2005;24(10):1451-1500

• Advanced Lung Failure & Transplantation
• Consensus Document
• Publications & Journals
• Pulmonology
• Standards & Guidelines

Primary graft dysfunction is a form of acute lung injury that follows the sequence of events inherent in the lung transplantation process, beginning with the brain death of the donor, pulmonary ischemia, preservation of donor tissue, transplantation, and reperfusion of donor tissue in the recipient. Despite numerous recent advances in organ preservation, surgical technique and peri-operative care, post-transplant allograft dysfunction is sufficiently common to warrant the use of a wide range of synonyms. These include ischemia–reperfusion injury, re-implantation response, re-implantation edema, reperfusion edema, non-cardiogenic pulmonary edema, early graft dysfunction, primary graft dysfunction (PGD), primary graft failure (PGF) and post-transplant acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). The expressions used to describe this condition are not perfectly synonymous, with some representing the most severe end of the spectrum of lung allograft ischemia–reperfusion injury and others representing less severe clinical syndromes.

Despite variation in studies, it is clear that PGD is responsible for significant morbidity and mortality after lung transplantation. Furthermore, with efforts in place to expand the donor pool, the expectation is that efforts to treat and/or prevent PGD will remain important to the field of lung transplantation.

The International Society for Heart and Lung Transplantation (ISHLT) Working Group on Primary Lung Graft Dysfunction was formed at the suggestion of the ISHLT Pulmonary Council in 2003. The purpose of this group was to review the available literature to provide a state-of-the-art, comprehensive series of documents to serve as a resource for clinicians and researchers. In addition, a major goal was to standardize consensus-defining criteria to facilitate future studies of PGD.

Part 1: Introduction and Methods

Authors

Jason D. Christie, MD, MS; Dirk Van Raemdonck, MD, PhD; Marc de Perrot, MD; Mark Barr, MD; Shaf Keshavjee, MD; Selim Arcasoy, MD; Jonathan Orens, MD

Read Part 1 at JHLT Download Part 1

Part 2: Definition

Authors

Jason D. Christie, MD, MS; Martin Carby, MBBS, BSc; Remzi Bag, MD; Paul Corris, MB; Marshall Hertz, MD; David Weill, MD

Read Part 2 at JHLT Download Part 2

Part 3: Donor-Related Risk Factors and Markers

Authors

Marc de Perrot, MD; Robert S. Bonser, MSBCh; John Dark, MB; Rosemary F. Kelly, MD; David McGiffin, MD; Rebecca Menza, RN; Octavio Pajaro, MD, PhD; Stephan Schueler, MD; Geert M. Verleden, MD, PhD

Read Part 3 at JHLT Download Part 3

Part 4: Recipient-Related Risk Facotrs and Markers

Authors

Mark L. Barr, MD; Steven M. Kawut, MD, MS; Timothy P. Whelan, MD; Reda Girgis, MD; Heidi Böttcher, MD; Joshua Sonett, MD; Wickii Vigneswaran, MD; David M. Follette, MD; Paul A. Corris, MB

Read Part 4 at JHLT Download Part 4

Part 5: Predictors and Outcomes

Authors

Selim M. Arcasoy, MD; Andrew Fisher, MD; Ramsey R. Hachem, MD; Masina Scavuzzo, RN, BSc; Lorraine B. Ware, MD

Read Part 5 at JHLT Download Part 5

Part 6: Treatment

Authors

Yaron Shargall, MD; Grisha Guenther, MD; Vivek N. Ahya, MD; Abbas Ardehali, MD; Arun Singhal, MD; Shaf Keshavjee, MD

Read Part 6 at JHLT Download Part 6