Primary graft dysfunction

Abstract

Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has a significant impact on short- and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex vivo lung perfusion is a strategy that may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review details recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers, and state-of-the-art technical developments affecting PGD.

Fig. 1

Radiographic progression of severe grade 3 primary graft dysfunction (at T0, T24, T48, T72, T216 after extubation, and T3 months) after bilateral sequential lung transplantation with unexpected massive fat embolism of the lungs of a 22-year-old donor from motor vehicle accident. The recipient was a 62-year-old female with emphysema who required 4 days of venovenous extracorporeal membrane oxygenation, 8 days of ventilator support, and 22 days of hospital stay. She recovered with a good functional activity.