Primary graft dysfunction (PGD) is a severe form of ischemia/reperfusion acute lung injury that is a major cause of early morbidity and mortality after lung transplantation. Survivors of PGD have worse long-term lung function and an increased chance of developing bronchiolitis obliterans syndrome (BOS), the manifestation of chronic rejection. This review examines the current state of PGD research in the context of a recent consensus statement by the International Society for Heart and Lung Transplantation (ISHLT) designed to standardize the definition of PGD in clinical research efforts. This article will review this definition and issues surrounding it, outcome studies examining the long-term effects of PGD, and the established clinical risk factors for PGD. Translational studies exploring the pathogenesis of PGD will be highlighted, and the current state of PGD prevention and management will also be described. Finally, we will summarize efforts at finding genetic and molecular markers for PGD and discuss future directions for PGD research.