Report of the ISHLT Working Group on Primary Lung Graft Dysfunction Part IV: Recipient-Related Risk Factors and Markers

Lung Transplantation for Cystic Fibrosis

“…The clinical picture is similar to acute respiratory distress syndrome and is characterized by severe impairments of oxygenation, diffuse alveolar infiltrates, and low pulmonary compliance (32). Pathologically, the graft exhibits diffuse alveolar damage.…”

“…Several issues may affect early outcomes, including the recipient's underlying disease, duration of cardiopulmonary bypass (if used) (29)(30)(31), size discrepancies at the site of anastomosis, and technique for initiating reperfusion. Complications that may be encountered during transplantation include inadequate intrathoracic exposure, intraoperative hypotension, poor hemostasis, compromised anastomosis, inadequate graft function, dynamic pulmonary hypertension, or metabolic and/or respiratory acidosis (32,33).…”

“…Primary graft dysfunction (PGD) is perhaps the most important problem postoperatively (32,(40)(41)(42)(43). Injuries to the graft can result from the physiological effects of brain death in the donor, ischemia related to harvest, preservation, and transport, and reperfusion injury at the time of implantation (27,(44)(45)(46).…”

“…This is a matter of considerable therapeutic and prophylactic variability among transplant centers. A variety of factors predispose to development of serious bacterial or fungal infections after transplant (55,56), including PGD, cytomegalovirus infection (57, 58), multiple transfusions (30,32), colonization with multiresistant organisms before transplant (59-62), enhanced or extensive immune suppression, renal failure, or episodes of acute rejection. Unfortunately, as therapeutic options for viral infection have improved, fungal organisms predominate, with an incidence of 15 to 35% (56,63).…”

Lung Transplantation: Advances and Roadblocks in Treatment

“…What is interesting is that no definitive studies have been performed that indicate that recipients' age play any role in the development of PGD. (Barr et al 2005;Christie et al 2003) Additionally, race (African-American), sex (female), and smoking history are all donor-dependent risk factors in the development of PGD. (Lee and Christie 2009) No conclusive studies of transplant recipients have explicitly delineated whether indication for transplantation correlates with development but it appears that idiopathic pulmonary fibrosis confers at least some increased risk of PGD.…”