Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine.
Division of Cardiovascular Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Curr Opin Organ Transplant. 2021 Jun 1;26(3):321-327. doi: 10.1097/MOT.0000000000000876.
Primary graft dysfunction (PGD) is a devastating complication in the acute postoperative lung transplant period, associated with high short-term mortality and chronic rejection. We review its definition, pathophysiology, risk factors, prevention, treatment strategies, and future research directions.
New analyses suggest donation after circulatory death and donation after brain death donors have similar PGD rates, whereas donors >55 years are not associated with increased PGD risk. Recipient pretransplant diastolic dysfunction and overweight or obese recipients with predominant abdominal subcutaneous adipose tissue have increased PGD risk. Newly identified recipient biomarkers and donor and recipient genes increase PGD risk, but their clinical utility remains unclear. Mixed data still exists regarding cold ischemic time and PGD risk, and increased PGD risk with cardiopulmonary bypass remains confounded by transfusions. Portable ex vivo lung perfusion (EVLP) may prevent PGD, but its use is limited to a handful of centers. Although updates to current PGD treatment are lacking, future therapies are promising with targeted therapy and the use of EVLP to pharmacologically recondition donor lungs.
There is significant progress in defining PGD and identifying its several risk factors, but effective prevention and treatment strategies are needed.
原发性移植物功能障碍（PGD）是急性肺移植术后的一种严重并发症，与短期高死亡率和慢性排斥反应有关。我们回顾了其定义、发病机制、危险因素、预防、治疗策略和未来的研究方向。
新的分析表明，循环死亡后捐献者和脑死亡后捐献者的 PGD 发生率相似，而 >55 岁的捐献者与 PGD 风险增加无关。移植前受者舒张功能障碍和超重或肥胖受者，以腹部皮下脂肪组织为主，PGD 风险增加。新发现的受者生物标志物和供者及受者基因增加了 PGD 风险，但它们的临床应用尚不清楚。关于冷缺血时间和 PGD 风险的混合数据仍然存在，体外膜肺氧合（ECMO）的使用增加与输血有关，仍存在 PGD 风险。便携式体外肺灌注（EVLP）可能预防 PGD，但由于需要输血，其应用仅限于少数中心。尽管目前缺乏更新的 PGD 治疗方法，但靶向治疗和使用 EVLP 对供肺进行药物调理的未来治疗方法很有前景。
在定义 PGD 和确定其几个危险因素方面取得了重大进展，但仍需要有效的预防和治疗策略。
