Report of the ISHLT Working Group on Primary Lung Graft Dysfunction Part III: Mechanisms: A 2016 Consensus Group Statement of the International Society for Heart and Lung Transplantation
2017; Elsevier BV; Volume: 36; Issue: 10 Linguagem: Inglês
10.1016/j.healun.2017.07.014
ISSN1557-3117
AutoresAndrew E. Gelman, Andrew J. Fisher, Howard J. Huang, Maher A. Baz, Ciara M. Shaver, Thomas M. Egan, M.S. Mulligan,
Tópico(s)Neonatal Respiratory Health Research
ResumoLungs with primary graft dysfunction (PGD) are characteristically edematous and have reduced compliance and impaired gas exchange. PGD is often attributed to ischemia–reperfusion injury (IRI). Because IRI has been shown to cause alterations in the integrity of the endothelial barrier and alveolar epithelial capacity to resorb fluid, 1 Matthay M.A. Robriquet L. Fang X. Alveolar epithelium: role in lung fluid balance and acute lung injury. Proc Am Thorac Soc. 2005; 2: 206-213 Crossref PubMed Scopus (152) Google Scholar , 2 Lee J.W. Fang X. Dolganov G. et al. Acute lung injury edema fluid decreases net fluid transport across human alveolar epithelial type II cells. J Biol Chem. 2007; 282: 24109-24119 Crossref PubMed Scopus (68) Google Scholar every transplanted lung is at risk of developing edema if there is any elevation of pulmonary venous pressure, either due to mechanical problems or left ventricular dysfunction. Previously, PGD has been attributed to events in the recipient, but pre-existing inflammatory status of the donor lung before recovery may also impact the development of PGD, as has been observed in brain-dead donors or donors after circulatory death. 3 Weber D.J. Gracon A.S. Ripsch M.S. et al. The HMGB1-RAGE axis mediates traumatic brain injury-induced pulmonary dysfunction in lung transplantation. Sci Transl Med. 2014; 6: 252 Crossref Scopus (68) Google Scholar , 4 Machuca T.N. Cypel M. Yeung J.C. et al. Protein expression profiling predicts graft performance in clinical ex vivo lung perfusion. Ann Surg. 2015; 261: 591-597 Crossref PubMed Scopus (66) Google Scholar Aside from early graft dysfunction, PGD is critically important due to its impact on long-term survival, because of the increased risk of bronchiolitis obliterans syndrome (BOS). 5 Huang H.J. Yusen R.D. Meyers B.F. et al. Late primary graft dysfunction after lung transplantation and bronchiolitis obliterans syndrome. Am J Transplant. 2008; 8: 2454-2462 Crossref PubMed Scopus (108) Google Scholar , 6 Daud S.A. Yusen R.D. Meyers B.F. et al. Impact of immediate primary lung allograft dysfunction on bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 2007; 175: 507-513 Crossref PubMed Scopus (290) Google Scholar
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