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- Title
A Focused Review on Primary Graft Dysfunction after Clinical Lung Transplantation: A Multilevel Syndrome.
- Authors
Van Slambrouck, Jan; Van Raemdonck, Dirk; Vos, Robin; Vanluyten, Cedric; Vanstapel, Arno; Prisciandaro, Elena; Willems, Lynn; Orlitová, Michaela; Kaes, Janne; Jin, Xin; Jansen, Yanina; Verleden, Geert M.; Neyrinck, Arne P.; Vanaudenaerde, Bart M.; Ceulemans, Laurens J.
- Abstract
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.
- Subjects
LUNGS; LUNG transplantation; REPERFUSION injury; SYNDROMES; LUNG injuries; CHEST X rays
- Publication
Cells (2073-4409), 2022, Vol 11, Issue 4, p745
- ISSN
2073-4409
- Publication type
Article
- DOI
10.3390/cells11040745