Primary lung allograft dysfunction: A clinical and experimental review

Primary graft dysfunction after lung transplantation continues to be a significant problem. Based on the presumption that ischemia-reperfusion injury is the principal cause of this highly morbid phenomenon, we presume that better understanding of the pathophysiology of the disease and better lung preservation based on this new knowledge will help reduce the incidence and severity of this problem. Here, we presented a detailed evaluation of parameters thatwe believe are useful to define and grade the severity of the disease spectrum. Future laboratory investigation is necessary to provide a better insight into the exact mechanisms leading to this clinical entity at the genetic level. Meanwhile, clinical comparison of these parameters should allow improved definitions and evolution of a universal scoring system while facilitating mechanistically informative studies. Translation of the laboratory data into clinical practice will require evaluation of these tools in welldesigned large multicenter trials. It is to be hoped that this review will provide a good insight into previously published benchmark data and facilitate protocol design for these badly needed investigations.