Baseline Lung Allograft Dysfunction: Definition, Timing, and Implications for Outcomes—An ISHLT Consensus Document

Published 11 August 2026

Jens Gottlieb, MD; Tereza Martinu, MD, MHS; Merel Hellemons, MD, PhD; David Darley, MBBS, BSc, PhD; Laurie Snyder, MD, MHS; Laura DiChiacchio, MD, PhD; Miranda Paraskeva, MBBS, MPH; Christian Benden, MD, MBA; Berta Saez-Gimenez, MD, PhD; Anoop Mohandas, MD, DNB, FNB, DESA; Letizia Corinna Morlacchi, MD; Joshua Diamond, MD, MSCE; Saskia Bos, MD, PhD; Erika Lease, MD; Geert Verleden, MD, PhD; Allan Glanville, MBBS, MD, FRACP; Kieran Halloran, MD, MSc

J Heart Lung Transplant. August 2026.

• Advanced Lung Failure & Transplantation
• Cardiothoracic Surgery
• Consensus Document
• JHLT
• Publications & Journals
• Pulmonology
• Standards & Guidelines

Lung allograft dysfunction after transplant is a major cause of mortality and morbidity in lung transplant recipients and poses a significant barrier to improving long-term survival and quality of life. While the constructs for acute lung allograft dysfunction (ALAD) and chronic lung allograft dysfunction (CLAD) capture declines in lung function, they do not address patients with subnormal but stable baseline function. This physiologic state–termed baseline lung allograft dysfunction (BLAD) – has been linked to impaired survival, though definitions in the literature have varied. The BLAD concept has also generated important discussions about whether it creates unrealistic expectations of normal post-transplant lung function.

The role of this consensus document is to clearly define the utility of the BLAD construct, to standardize the definition for future clinical and research use, and to summarize what is known about its potential risk factors, causes, and association with outcomes.

Read at JHLT