2016 Report of the ISHLT Working Group on Primary Lung Graft Dysfunction

Published 26 July 2017

J Heart Lung Transplant. Oct 2017;36(10):1097-103

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

Primary graft dysfunction (PGD) refers to the syndrome of acute lung injury early after lung transplantation (LTx). In 2005, based on the need for a reliable and valid definition with clear taxonomy, the first International Society for Heart and Lung Transplantation (ISHLT) Working Group on PGD proposed a consensus-based standardized definition and grading system. This definition has since been used to characterize PGD clinically by diffuse alveolar infiltrates on chest X-ray imaging, with the degree of associated hypoxemia determining its severity

Since the publication of the 2005 ISHLT PGD consensus documents, multiple studies have validated the PGD definition, estimated the incidence of PGD, and described its risk factors. However, as detailed below, questions have arisen regarding the terminology, sub-phenotypes, optimal timing of measurement, and range of the grading scale. In addition, the 2012 Berlin definition of grading of the adult respiratory distress syndrome (ARDS) raised some relevant issues to PGD grading, including the potential for expanded severity grading. Furthermore, since 2005, clinical trials of novel organ preservation technologies and other therapeutics have proposed PGD as a trial outcome.

Thus, based on these considerations and the potential to improve the reliability, validity, and clarity of the PGD definition, ISHLT convened a second PGD Consensus Group to develop this updated version.

Part 1: Definition and Grading

Authors

Gregory I. Snell, FRACP, MBB, MD; Roger D. Yusen, MD, MPH; David Weill, MD; Martin Strueber, MD; Edward Garrity, MD; Anna Reed, MBChB, PhD, FRCP; Andres Pelaez, MD; Timothy P. Whelan, MD; Michael Perch, MD; Remzi Bag, MD; Marie Budev, DO, MPH; Paul A. Corris, MB, FRCP; Maria M. Crespo, MD; Chad Witt, MD; Edward Cantu, MD, MS; Jason D. Christie, MD, MS

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Part 2: Epidemiology, Risk Factors, and Outcomes

Authors

Joshua M. Diamond, MD; Selim Arcasoy, MD; Cassie C. Kennedy, MD; Michael Eberlein, MD, PhD; Jonathan P. Singer, MD; Glenda M. Patterson, MD; Jeffrey D. Edelman, MD; Gundeep Dhillon, MD, MPH; Tahuanty Pena, MD, MS; Steven M. Kawut, MD, MS; James C. Lee, MD; Reda Girgis, MD; John Dark, MBBS, FRCS; Gabriel Thabut, MD, PhD

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Part 3: Mechanisms

Authors

Andrew E. Gelman, PhD; Andrew J. Fisher, PhD, FRCP; Howard J. Huang, MD; Maher A. Baz, MD; Ciara M. Shaver, MD, PhD; Thomas M. Egan, MD, Msc; Micheal S. Mulligan, MD

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Part 4: Prevention and Treatment

Authors

Dirk Van Raemdonck, MD, PhD; Matthew G. Hartwig, MD; Marshall I. Hertz, MD; R. Duane Davis, MD, MBA; Marcelo Cypel, MD, MSc; Don Hayes Jr, MD, MS; Steve Ivulich, BPharm; Jasleen Kukreja, MD; Erika D. Lease, MD; Gabriel Loor, BS, MD; Olaf Mercier, MD, PhD; Luca Paoletti, MD; Jasvir Parmar, BM, PhD; Reinaldo Rampolla, MD; Keith Wille, MD, MSPH; Rajat Walia, MD; Shaf Keshavjee, MD, MSc

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