ISHLT consensus statement on BLAD in lung transplant recipients

An International Society for Heart and Lung Transplantation (ISHLT) consensus document on baseline lung allograft dysfunction (BLAD) in lung transplant recipients was published in The Journal of Heart and Lung Transplantation by Gottlieb et al. A total of 17 actionable recommendations were developed by a panel of international experts using a structured, 3-round Delphi process addressing the definition, timing, causes, and outcomes in patients with BLAD.

Key data: The consensus group defines BLAD as failure of baseline forced expiratory volume in 1 second (FEV1), baseline forced vital capacity (FVC), or both to reach normal thresholds. BLAD subtypes include isolated low FEV1 (BLAD-iFEV1), isolated low FVC (BLAD-iFVC), or both (BLAD-FEV1&FVC), with severity graded according to FEV1% predicted. The BLAD definition should be based on spirometry; however, suspected BLAD can be diagnosed in the absence of spirometry if there is evidence of impaired baseline lung function. BLAD is best assessed at 1-year post-transplant and thereafter and can arise from allograft-related causes or factors external to the allograft. Studies have demonstrated that BLAD is associated with reduced survival following lung transplantation and may also be associated with poor patient-centered outcomes. 

Key learning: This ISHLT consensus standardizes the definition, timing, and phenotyping of BLAD assessment in lung transplant recipients, providing a framework to inform clinical practice, prognostication, and future preventive and therapeutic strategies.