ISHLT Consensus Statement on Acute Lung Allograft Dysfunction (ALAD): Definition, Etiology, Diagnostic and Therapeutic Approaches, and Research Priorities

This International Society for Heart and Lung Transplantation (ISHLT) consensus statement formalizes the definition, diagnostic framework, and therapeutic approach for acute lung allograft dysfunction (ALAD). Recognizing the need to standardize acute, potentially reversible graft function decline that may precede chronic lung allograft dysfunction (CLAD), the committee postulated a standard definition of ALAD based on spirometry, clinical symptoms, and the duration of symptoms. The statement stratifies etiologies into alloimmune, non-alloimmune, and idiopathic categories, mandating core investigations such as donor-specific antibody testing and the tailored use of bronchoscopy or computed tomography for moderate-to-severe presentations. Therapeutically, the consensus advocates for etiology-directed management, endorsing empiric broad-spectrum antibiotics and augmented immunosuppression, alongside advanced mechanical support such as extracorporeal membrane oxygenation in severe or rapidly progressive cases to mitigate irreversible graft injury.