Abstract
Primary graft dysfunction (PGD) is a form of acute lung injury that results from ischemia
reperfusion injury (IRI) and is the major cause of early posttransplant morbidity
and mortality. Patients who survive PGD have decreased quality of life, an increased
risk of chronic lung allograft dysfunction, specifically bronchiolitis obliterans
syndrome, and a significantly increased risk of death. In 2017, the International
Society for Heart and Lung Transplantation released updated consensus statements on
the PGD definition, most up-to-date PGD risk factors, mechanisms of PGD development,
and the state-of-the-art for PGD therapeutics. Risk factor identification has led
to the development of PGD predictive algorithms, although their clinical utility remains
limited. Ongoing areas of controversy and discussion include further refinements to
the PGD grading scheme to account for technologic advances such as extracorporeal
membrane oxygenation and the increased utilization of high flow nasal cannula, the
use of PGD as an outcome measure in clinical trials of ex vivo lung perfusion, enhancement
of predictive algorithms incorporating biochemical risk factors, and the need for
development of therapies targeted at improving PGD outcomes.
Keywords
primary graft dysfunction - lung transplantation
