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

Published 13 May 2026

Stephen Juvet, MD, PhD; Gregory Snell, MBBS, FRACP, MD; Saskia Bos, MD, PhD; Marie Budev, DO, MPH; John Greenland, MD, PhD; Kieran Halloran, MD, MSc; Sandra Lindstedt, MD, PhD; Laurie Snyder, MD, MHS; Rayid Abdulqawi, MD, PhD; Atefeh Abedini; Selim Arcasoy, MD, MPH; Meghan Aversa, MD; Alberto Benazzo, PhD; Daniel Calabrese, MD; Fiorella Calabrese, MD; Marlene Cano, MD, PhD; Kevin Chan, MD; Satish Chandrashekaran, MD; David Darley, MBBS, BSc (Hons), FRACP, PhD; Amir Emtiazjoo, MD, MSc; Tara Fallah, PharmD; Laurent Godinas, MD, PhD; Rene Hage, MD, PhD; Don Hayes, Jr., MD, MS, MEd, MBA; Howard Huang, MD; Jana Kleinerova, MUDr; Sakhee Kotecha; Akshay Kumar, MD; Francesca Lunardi, MD, ScD, PhD; Jorfe Mallea, MD; Tereza Martinu, MD, MHS; Federica Meloni, MD, PhD; Anoop Mohandas, MD, FNB, DNB, DESA; Eric Morrell, MD; Arun Nair, MD, FRCP Edin; Rene Novysedlak; Michael Perch, MD; Federica Pezzuto; Clement Picard, MD; Peter Riddell, MBBS; Anja Roden, MD; Justin Rosenheck, DO; Julie Semenchuck, BSc, MD; Unmil Shah, MD, DNB; Heather Strah, MD; Laneshia Tague, MD, MSCI; Rade Tomic, MD; Anil Trindade, MD; Katherine Vendervest, MD; Geert Verleden, MD, PhD, FERS; Glen Westall, FRACP, PhD; Ciara Shaver, MD, PhD.

J Heart Lung Transplant. May 2026.

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

Although the syndrome of Acute Lung Allograft Dysfunction (ALAD) has appeared with increasing frequency in the lung transplant literature over the past decade, there has been significant variation in how it has been defined, ranging from mild dysfunction to severe graft failure. At the ALAD Symposium held during the ISHLT Annual Meeting in April 2024, several needs were identified including establishing:

1. A consensus definition of ALAD
2. An understanding of etiological factors for ALAD
3. A universal adaptable framework for the evaluation of ALAD containing clarification of the sequence of diagnostic evaluation
4. Treatment approaches based on severity of ALAD
5. Foundation for future research and clinical trials addressing this entity.

In response, the ISHLT assembled a multinational, multidisciplinary diverse group of ISHLT members to generate a consensus statement on ALAD. The group included transplant pulmonologists, transplant surgeons, infectious disease specialists, pathologists, pediatricians, pharmacists, and scientists from 16 different countries on 4 continents.

The primary aims of this ISHLT Consensus Statement on ALAD are to standardize the nomenclature of ALAD, define its contributing etiologies, provide a suggested framework for diagnostic testing and therapeutic decision making, and identify research opportunities to facilitate collaboration and benchmarking among transplant centers in investigating the pathogenesis, possible prevention, and further treatment of ALAD.

Read at JHLT