2016 International Society for Heart and Lung Transplantation primary graft dysfunction definition

Grade	Pulmonary edema on chest radiograph	PaO₂/FiO₂ ratio
PGD grade 0	No	Any
PGD grade 1	Yes	>300
PGD grade 2	Yes	200 to 300
PGD grade 3	Yes	<200

Grade severity notes:

Patients with no evidence of pulmonary edema on chest radiograph are considered grade 0. Absence of invasive mechanical ventilation should be graded according to the PaO₂/FiO₂ ratio, using methods similar to those receiving mechanical ventilation.
If PaO₂ is not available for calculation of a PaO₂/FiO₂ ratio, then an oxygen saturation/FiO₂ ratio should be calculated and the 200 and 300 PGD grading cutoffs should be adjusted to 235 and 315. Use of nitric oxide, aerosolized epoprostenol, or other pharmacologic agents that may improve oxygenation should not change grading methods. Use of extracorporeal lung support (ECLS) with bilateral pulmonary edema on chest radiograph image should be graded as grade 3 and ECLS should be explicitly recorded. The use of ECLS for non-hypoxic indications without pulmonary edema on chest radiograph imaging should be considered ungradable and explicitly recorded separately.

Time window notes:

PGD is graded at four time points, every 24 hours, over the first 72 hours after transplantation (T0, T24, T48, and T72 hours). Time starts at reperfusion of second lung. T0, T24, T48, and T72 have time windows ± 6 hours. If multiple blood gas values are available, the worst PaO₂/FiO₂ ratio on a given calendar day should be used.

Other notes:

PaO₂/FiO₂ should ideally be measured on positive end-expiratory pressure of 5 cm H₂O at FiO₂ of 1.0 while patients are on mechanical ventilation; however, grading should not be altered for other settings. For altitudes higher than 1000 m, use of an appropriate correction factor is recommended. For comparative purposes, single lung transplantation is recommended to be reported separately from bilateral lung transplant without change in grading methodology.

FiO₂: fraction of inspired oxygen; PaO₂: partial pressure of arterial oxygen; PGD: primary graft dysfunction

Reproduced from: Snell GI, Yusen RD, Weill D, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading-A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2017; 36:1097. Table used with the permission of Elsevier Inc. All rights reserved.

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2016 International Society for Heart and Lung Transplantation primary graft dysfunction definition