Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic at the end of December 2019, more than 85% of the population in China has been infected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly affects the respiratory system, especially the lungs. The mortality rate of patients with severe infection is high. A percentage of 6% to 10% of patients will eventually develop into COVID-related acute respiratory distress syndrome (CARDS), which requires mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support. Some patients who survive acute lung injury will subsequently develop post COVID-19 pulmonary fibrosis (PCPF). Both fully treated CARDS and severe PCPF are suitable candidates for lung transplantation. Due to the special course, evaluation strategies are different from those used in patients with common end-stage lung disease. After lung transplantation in COVID-19 patients, special treatment is required, including standardized nucleic acid testing for the novel coronavirus, adjustment strategy of immunosuppressive drugs, and rational use of antiviral drugs, which is a big challenge for the postoperative management of lung transplantation. This consensus was evidence-based written and was reached by experts after multiple rounds of discussions, providing reference for assessment and postoperative management of patients with interstitial pneumonia after COVID-19 infection.
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.
In order to promote the development of lung transplantation nursing in China, and to provide patients with comprehensive, safe, scientific and standardized surgical nursing, thoracic surgery experts and nursing experts from medical institutions qualified for lung transplantation were convened for extensive consultation. This consensus was developed in accordance with the principles of evidence-based medicine and based on the published best evidence in Chinese and English. This consensus aims to solve the potential problems in nursing cooperation in lung transplantation surgery to the greatest extent, and provide a scientific and standardized nursing cooperation plan for lung transplantation surgeries.