Review 2: Primary graft dysfunction after lung transplant—pathophysiology, clinical considerations and therapeutic targets

Abstract

Primary graft dysfunction (PGD) is one of the most common complications in the early postoperative period and is the most common cause of death in the first postoperative month. The underlying pathophysiology is thought to be the ischaemia–reperfusion injury that occurs during the storage and reperfusion of the lung engraftment; this triggers a cascade of pathological changes, which result in pulmonary vascular dysfunction and loss of the normal alveolar architecture. There are a number of surgical and anaesthetic factors which may be related to the development of PGD. To date, although treatment options for PGD are limited, there are several promising experimental therapeutic targets. In this review, we will discuss the pathophysiology, clinical management and potential therapeutic targets of PGD.

Ischemia-reperfusion Injury in the Transplanted Lung: A Literature Review

“… 2 , 3 It has been described clinically as primary graft dysfunction (PGD) and is associated with significant short- and long-term morbidity and mortality including progression to bronchiolitis obliterans syndrome (BOS). 4 - 6 Despite modern advances in organ preservation and perioperative support of the lung transplant recipient, PGD continues to occur in up to 30% of patients. 2 , 5 , 6 Clinically, PGD is defined by hypoxemia, pulmonary edema, and bilateral pulmonary infiltration on radiography without alternative explanation.…”

“…PGD is associated with increased duration of mechanical ventilation, hospital length of stay, and overall mortality. 3 , 4 , 7 In the long term, PGD is a major risk factor for the development of BOS and chronic lung allograft dysfunction. 8 , 9 …”

Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

“…PGD severity is qualified by the extent of hypoxemia with reference to the administered FiO 2 (PaO 2 /FiO 2 ratio) (Table 1). LIRI and PGD are associated with adverse outcomes including prolonged mechanical ventilation, increased post-operative length of stay, and increased mortality [20,41,42]. The presence of stage 3 PGD within 72 h is strongly associated with poor outcomes [43].…”

“…As previously mentioned, PGD due to LIRI has a reported incidence of 11-57% following LTx with a significant impact on survival outcomes [11,123]. PGD is also associated with increased short-and long-term morbidity, including the development of bronchiolitis obliterans syndrome (BOS) [18,42].…”

Journal of anesthesia, history, current status, and future direction

“…Editorial board members coordinate articles that provide cutting-edge information on hot topics in the field of anesthesiology. For instance, six invited review articles were published between 2019 and 2020, highlighting pediatric pain management [ 3 ], labor analgesia [ 4 ], neurotoxicity of general anesthesia [ 5 ], postoperative immune rejection in transplant patients [ 6 , 7 ], and neurobiology of abnormal pain [ 8 ]. We are delighted to see that these reviews have attracted much scientific attention from our readers.…”