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Primary graft dysfunction: what we know

Many advances in lung transplant have occurred over the last few decades in the understanding of primary graft dysfunction (PGD) though effective prevention and treatment remain elusive. This review will cover prior understanding of PGD, recent findings, and directions for future research. A consens...

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Autores principales: Clausen, Emily, Cantu, Edward
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662499/
https://www.ncbi.nlm.nih.gov/pubmed/34992840
http://dx.doi.org/10.21037/jtd-2021-18
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author Clausen, Emily
Cantu, Edward
author_facet Clausen, Emily
Cantu, Edward
author_sort Clausen, Emily
collection PubMed
description Many advances in lung transplant have occurred over the last few decades in the understanding of primary graft dysfunction (PGD) though effective prevention and treatment remain elusive. This review will cover prior understanding of PGD, recent findings, and directions for future research. A consensus statement updating the definition of PGD in 2016 highlights the growing complexity of lung transplant perioperative care taking into account the increasing use of high flow oxygen delivery and pulmonary vasodilators in the current era. PGD, particularly more severe grades, is associated with worse short- and long-term outcomes after transplant such as chronic lung allograft dysfunction. Growing experience have helped identify recipient, donor, and intraoperative risk factors for PGD. Understanding the pathophysiology of PGD has advanced with increasing knowledge of the role of innate immune response, humoral cell immunity, and epithelial cell injury. Supportive care post-transplant with technological advances in extracorporeal membranous oxygenation (ECMO) remain the mainstay of treatment for severe PGD. Future directions include the evolving utility of ex vivo lung perfusion (EVLP) both in PGD research and potential pre-transplant treatment applications. PGD remains an important outcome in lung transplant and the future holds a lot of potential for improvement in understanding its pathophysiology as well as development of preventative therapies and treatment.
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spelling pubmed-86624992022-01-05 Primary graft dysfunction: what we know Clausen, Emily Cantu, Edward J Thorac Dis Review Article on Lung Transplantation: Past, Present, and Future Many advances in lung transplant have occurred over the last few decades in the understanding of primary graft dysfunction (PGD) though effective prevention and treatment remain elusive. This review will cover prior understanding of PGD, recent findings, and directions for future research. A consensus statement updating the definition of PGD in 2016 highlights the growing complexity of lung transplant perioperative care taking into account the increasing use of high flow oxygen delivery and pulmonary vasodilators in the current era. PGD, particularly more severe grades, is associated with worse short- and long-term outcomes after transplant such as chronic lung allograft dysfunction. Growing experience have helped identify recipient, donor, and intraoperative risk factors for PGD. Understanding the pathophysiology of PGD has advanced with increasing knowledge of the role of innate immune response, humoral cell immunity, and epithelial cell injury. Supportive care post-transplant with technological advances in extracorporeal membranous oxygenation (ECMO) remain the mainstay of treatment for severe PGD. Future directions include the evolving utility of ex vivo lung perfusion (EVLP) both in PGD research and potential pre-transplant treatment applications. PGD remains an important outcome in lung transplant and the future holds a lot of potential for improvement in understanding its pathophysiology as well as development of preventative therapies and treatment. AME Publishing Company 2021-11 /pmc/articles/PMC8662499/ /pubmed/34992840 http://dx.doi.org/10.21037/jtd-2021-18 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Lung Transplantation: Past, Present, and Future
Clausen, Emily
Cantu, Edward
Primary graft dysfunction: what we know
title Primary graft dysfunction: what we know
title_full Primary graft dysfunction: what we know
title_fullStr Primary graft dysfunction: what we know
title_full_unstemmed Primary graft dysfunction: what we know
title_short Primary graft dysfunction: what we know
title_sort primary graft dysfunction: what we know
topic Review Article on Lung Transplantation: Past, Present, and Future
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662499/
https://www.ncbi.nlm.nih.gov/pubmed/34992840
http://dx.doi.org/10.21037/jtd-2021-18
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