Chinese experts 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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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.

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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.	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.
10.	Machuca TN, Cypel M. Ex vivo lung perfusion. J Thorac Dis, 2014, 6(8): 1054-1062.
11.	Halloran PF. T cell-mediated rejection of kidney transplants: A personal viewpoint. Am J Transplant, 2010, 10(5): 1126-1134.
12.	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. 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.
10. Machuca TN, Cypel M. Ex vivo lung perfusion. J Thorac Dis, 2014, 6(8): 1054-1062.
11. Halloran PF. T cell-mediated rejection of kidney transplants: A personal viewpoint. Am J Transplant, 2010, 10(5): 1126-1134.
12. 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

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