Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium.
Department of Thoracic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium.
Cells. 2022 Feb 21;11(4):745. doi: 10.3390/cells11040745.
Primary graft dysfunction (PGD) is the clinical syndrome of acute lung injury after lung transplantation (LTx). However, PGD is an umbrella term that encompasses the ongoing pathophysiological and -biological mechanisms occurring in the lung grafts. Therefore, we aim to provide a focused review on the clinical, physiological, radiological, histological and cellular level of PGD. PGD is graded based on hypoxemia and chest X-ray (CXR) infiltrates. High-grade PGD is associated with inferior outcome after LTx. Lung edema is the main characteristic of PGD and alters pulmonary compliance, gas exchange and circulation. A conventional CXR provides a rough estimate of lung edema, while a chest computed tomography (CT) results in a more in-depth analysis. Macroscopically, interstitial and alveolar edema can be distinguished below the visceral lung surface. On the histological level, PGD correlates to a pattern of diffuse alveolar damage (DAD). At the cellular level, ischemia-reperfusion injury (IRI) is the main trigger for the disruption of the endothelial-epithelial alveolar barrier and inflammatory cascade. The multilevel approach integrating all PGD-related aspects results in a better understanding of acute lung failure after LTx, providing novel insights for future therapies.
原发性移植物功能障碍（PGD）是肺移植（LTx）后急性肺损伤的临床综合征。然而，PGD 是一个涵盖肺移植物中持续发生的病理生理和生物学机制的总称。因此，我们旨在对 PGD 在临床、生理、放射、组织学和细胞水平上的相关内容进行重点综述。PGD 根据低氧血症和胸部 X 射线（CXR）浸润情况进行分级。高等级 PGD 与 LTx 后的不良预后相关。肺水肿是 PGD 的主要特征，它会改变肺顺应性、气体交换和循环。传统的 CXR 可以粗略估计肺水肿，而胸部 CT 则可以进行更深入的分析。大体上，间质性和肺泡性水肿可以在脏层肺表面下区分开来。在组织学水平上，PGD 与弥漫性肺泡损伤（DAD）的模式相关。在细胞水平上，缺血再灌注损伤（IRI）是破坏内皮-上皮肺泡屏障和炎症级联反应的主要触发因素。整合所有与 PGD 相关方面的多层次方法可以更好地了解 LTx 后的急性肺衰竭，为未来的治疗提供新的见解。
