Primary graft dysfunction

Semin Respir Crit Care Med. 2013 Jun;34(3):305-319. doi: 10.1055/s-0033-1348474. Epub 2013 Jul 2.


Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has a significant impact on short- and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex vivo lung perfusion is a strategy that may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review details recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers, and state-of-the-art technical developments affecting PGD.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acute Lung Injury / epidemiology
  • Acute Lung Injury / etiology*
  • Acute Lung Injury / physiopathology
  • Animals
  • Biomarkers / metabolism
  • Genetic Markers
  • Humans
  • Lung Transplantation / methods*
  • Primary Graft Dysfunction / epidemiology
  • Primary Graft Dysfunction / physiopathology*
  • Primary Graft Dysfunction / prevention & control
  • Risk Assessment / methods
  • Severity of Illness Index
  • Time Factors
  • Tissue and Organ Procurement / methods


  • Biomarkers
  • Genetic Markers