REVIEWS   

Minerva Pneumologica 2014 December;53(4):137-53

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Primary graft dysfunction in lung transplant recipients: definition, pathogenesis and clinical management

Riera J.

Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

Primary graft dysfunction (PGD) is a form of inflammatory lung edema that hinders respiratory function recovery within the first 72 hours after lung transplantation. The criteria for its definition are unspecific and current investigations are trying to identify elements that may be added to these criteria and, thus, enhance the relation between the definition and the short-term and long-term outcomes. PGD has complex pathogenic mechanisms that revolve around the ischemia-reperfusion injury. In the recent years new knowledge has been generated on this field. Biomarkers may help on prevention, early diagnosis and monitoring of the pathology. Furthermore, an accurate screening of the risk factors of the donor and the recipient for PGD, an adequate management of the donor before lung explant and a cautious storage and transport of the graft before implantation may reduce the possibilities of PGD occurrence. When it develops, the therapy is predominantly focused on supportive care and lung-protective ventilation. The present article reviews the published literature about PGD. Firstly its current definition is examined. Then, the main evidence about the physiopathology of PGD, particularly about its risk factors and related biomarkers, is summarized. Finally the clinical management, based principally on prevention and supportive measures, is discussed.