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Semin Respir Crit Care Med 2013; 34(03): 305-319
DOI: 10.1055/s-0033-1348474
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Primary Graft Dysfunction

Yoshikazu Suzuki
1   Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
*   These authors have contributed equally to this work.
,
Edward Cantu
1   Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
*   These authors have contributed equally to this work.
,
Jason D. Christie
2   Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
3   Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
02 July 2013 (online)

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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.

Keywords

primary graft dysfunction - lung transplantation - ischemia-reperfusion injury and repair - high-risk donor lung - ex vivo lung perfusion

Funding Sources

AI063589, HL087115, HL081619, HL096845, HL115354, HL116656, RWJ11642.


 

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