Primary graft dysfunction

Abstract

Primary graft dysfunction is the major determinant of early morbidity and mortality after lung transplantation. Survivors of primary graft dysfunction have a protracted recovery and worse long-term mortality in ensuing years. Furthermore, primary graft dysfunction survivors may have a greater risk of bronchiolitis obliterans syndrome. Early studies of primary graft dysfunction often defined the disease differently. The resultant difficulty in synthesizing conclusions spurred the International Society for Heart and Lung Transplantation to adopt a consensus definition and classification schema. This review examines the early primary graft dysfunction research as a context for newer findings, and highlights some of the advances made in the field since the adoption of the consensus definition. Clinical research incorporating the International Society for Heart and Lung Transplantation definition has provided a standard platform to advance the understanding of primary graft dysfunction incidence, outcomes, pathophysiology, risk factors, prevention, and management. Recent laboratory research has advanced our understanding of pulmonary ischemia–reperfusion injury and suggested potential novel therapies. This article will review previous research on primary graft dysfunction etiology, risks and outcomes, and update the reader on recent advances in the field.