Primary Graft Dysfunction in Lung Transplantation

Primary graft dysfunction (PGD) after lung transplantation is a major source of morbidity and mortality in the post operative patient. Clinical features of this early graft dysfunction include reduced gas exchange, reduced pulmonary compliance, and patchy pulmonary infiltrates seen on chest X-ray. PGD has also been found to be an independent predictor for the development and progression of bronchiolitis obliterans. Multiple strategies have been developed to reduce primary graft dysfunction in lung transplantation. These include ventilatory techniques to reduce airway pressures both during procurement and implantation, development of improved organ preservation solutions, use of leukocyte filters on the cardiopulmonary bypass circuits, controlled reperfusion of the implanted organ, pharmacological agents to attenuate the inflammatory component of the ischemia reperfusion injury (IRI), antioxidants, surfactant, nitric oxide, prostacyclin and a variety of other agents.In this chapter we will review the pathophysiology of PGD in lung transplantation,examine the evidence for the currently used measures and discuss the currently available management options.