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.
Severe viral pneumonia caused by highly pathogenic viruses frequently leads to acute respiratory distress syndrome (ARDS) and may progress to irreversible pulmonary fibrosis and chronic respiratory failure. Lung transplantation has become a crucial therapeutic option for such end-stage lung injuries. However, due to the heterogeneous clinical course and lack of standardized assessment, identifying transplant timing and suitable candidates remains challenging. This multidisciplinary consensus, based on both international evidence and clinical experience, outlines key principles and structured recommendations for lung transplant evaluation in these patients. The framework addresses transplant indications, imaging and functional assessment of irreversibility, virologic control criteria, potential survival benefit, and postoperative recovery capacity. The consensus emphasizes initiating evaluation during the “window of opportunity”, when lung damage is irreversible, infection is controlled, and the patient remains clinically stable. Recommendations are graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide evidence-based decision-making and improve clinical implementation and transplant outcomes.