Chinese expert consensus on early warning and standardized treatment pathway for primary graft dysfunction after lung transplantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 Thoracic Surgery Society of the Shanghai Medical Association , Thoracic Surgery Subcommittee of the Shanghai Medical Doctor Association , The National Alliance for Enhancing Clinical Competence in General Thoracic Surgery

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, P. R. China;

Corresponding author：

Thoracic Surgery Society of the Shanghai Medical Association, Email: chenthoracic@163.com

Keywords：

Lung transplantation; primary graft dysfunction; risk prediction; standardized treatment pathway; multidisciplinary team; expert consensus

DOI：

10.7507/1007-4848.202504107

Video：

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Abstract Full text Figures/Tables Video References Cited by

Primary graft dysfunction (PGD) is the most common and significant complication affecting long-term survival rates after lung transplantation. The occurrence of PGD is closely related to donor-recipient risk factors, surgical procedures, and perioperative management. Early identification and standardized intervention are crucial for improving prognosis. This consensus was developed by a multidisciplinary expert group in the field of lung transplantation in China, based on a systematic literature review, evidence-based medical evidence, and clinical practice experience. It systematically outlines the definition and classification of PGD, the main pathological mechanisms, donor-recipient and perioperative risk factors, and establishes a dynamic early warning mechanism and graded treatment standard process. This consensus emphasizes the construction of a complete closed-loop management system through comprehensive preoperative assessment, multiparameter monitoring during surgery, standardized postoperative intervention, and follow-up management after discharge. The aim is to standardize clinical practices, reduce the incidence of PGD, promote graft function recovery, and improve long-term survival rates for patients. The consensus employs the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the strength of recommendations and the level of evidence, providing a scientific, systematic, and actionable clinical guidance framework for lung transplantation centers.

Citation： Thoracic Surgery Society of the Shanghai Medical Association, Thoracic Surgery Subcommittee of the Shanghai Medical Doctor Association, The National Alliance for Enhancing Clinical Competence in General Thoracic Surgery. Chinese expert consensus on early warning and standardized treatment pathway for primary graft dysfunction after lung transplantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(7): 897-904. doi: 10.7507/1007-4848.202504107 Copy

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2.	Mollberg NM, Farjah F, Howell E, et al. Impact of primary caregivers on long-term outcomes after lung transplantation. J Heart Lung Transplant, 2015, 34(1): 59-64.
3.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
4.	Christie JD, Carby M, Bag R, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part Ⅱ: Definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2005, 24(10): 1454-1459.
5.	Hunt ML, Cantu E. Primary graft dysfunction after lung transplantation. Curr Opin Organ Transplant, 2023, 28(3): 180-186.
6.	Reshef R, Luskin MR, Kamoun M, et al. Association of HLA polymorphisms with post-transplant lymphoproliferative disorder in solid-organ transplant recipients. Am J Transplant, 2011, 11(4): 817-825.
7.	Eberlein M, Reed RM, Bolukbas S, et al. Lung size mismatch and primary graft dysfunction after bilateral lung transplantation. J Heart Lung Transplant, 2015, 34(2): 233-240.
8.	Tague LK, Bedair B, Witt C, et al. Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation. J Heart Lung Transplant, 2021, 40(10): 1212-1222.
9.	Crotti S, Iotti GA, Lissoni A, et al. Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes. Chest, 2013, 144(3): 1018-1025.
10.	Benck L, Kransdorf EP, Emerson DA, et al. Recipient and surgical factors trigger severe primary graft dysfunction after heart transplant. J Heart Lung Transplant, 2021, 40(9): 970-980.
11.	Machuca TN, Cypel M. Ex vivo lung perfusion. J Thorac Dis, 2014, 6(8): 1054-1062.
12.	Halloran PF. T cell-mediated rejection of kidney transplants: A personal viewpoint. Am J Transplant, 2010, 10(5): 1126-1134.
13.	Dellagrammaticas D, Lewis SC, Gough MJ. Is heparin reversal with protamine after carotid endarterectomy dangerous? Eur J Vasc Endovasc Surg, 2008, 36(1): 41-44.

1. Diamond JM, Lee JC, Kawut SM, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med, 2013, 187(5): 527-534.
2. Mollberg NM, Farjah F, Howell E, et al. Impact of primary caregivers on long-term outcomes after lung transplantation. J Heart Lung Transplant, 2015, 34(1): 59-64.
3. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
4. Christie JD, Carby M, Bag R, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part Ⅱ: Definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2005, 24(10): 1454-1459.
5. Hunt ML, Cantu E. Primary graft dysfunction after lung transplantation. Curr Opin Organ Transplant, 2023, 28(3): 180-186.
6. Reshef R, Luskin MR, Kamoun M, et al. Association of HLA polymorphisms with post-transplant lymphoproliferative disorder in solid-organ transplant recipients. Am J Transplant, 2011, 11(4): 817-825.
7. Eberlein M, Reed RM, Bolukbas S, et al. Lung size mismatch and primary graft dysfunction after bilateral lung transplantation. J Heart Lung Transplant, 2015, 34(2): 233-240.
8. Tague LK, Bedair B, Witt C, et al. Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation. J Heart Lung Transplant, 2021, 40(10): 1212-1222.
9. Crotti S, Iotti GA, Lissoni A, et al. Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes. Chest, 2013, 144(3): 1018-1025.
10. Benck L, Kransdorf EP, Emerson DA, et al. Recipient and surgical factors trigger severe primary graft dysfunction after heart transplant. J Heart Lung Transplant, 2021, 40(9): 970-980.
11. Machuca TN, Cypel M. Ex vivo lung perfusion. J Thorac Dis, 2014, 6(8): 1054-1062.
12. Halloran PF. T cell-mediated rejection of kidney transplants: A personal viewpoint. Am J Transplant, 2010, 10(5): 1126-1134.
13. Dellagrammaticas D, Lewis SC, Gough MJ. Is heparin reversal with protamine after carotid endarterectomy dangerous? Eur J Vasc Endovasc Surg, 2008, 36(1): 41-44.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chinese expert consensus on early warning and standardized treatment pathway for primary graft dysfunction after lung transplantation

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