Primary Graft Dysfunction

I. Introduction Primary graft dysfunction (PGD)—referred to previously as reperfusion edema, reimplantation response, or primary graft failure-is a form of acute lung injury thought due largely to ischemia/reperfusion insults that accompany the lung transplantation processes of organ explantation, storage, and reimplantation. PGD affects 10% to 25% of all lung transplants and is the leading cause of early morbidity and mortality (1-7). Thirtyday mortality rates are up to eightfold higher in patients with severe PGD as compared to those without PGD. In addition, PGD survivors have significantly impaired long-term function (5) and an increased risk of bronchiolitis obliterans syndrome (BOS) (8).