Primary graft dysfunction (PGD) is a form of acute lung injury after transplantation characterized by hypoxemia and the development of alveolar infiltrates on chest radiograph that occurs within 72 hours of reperfusion. PGD is among the most common early complications following lung transplantation and significantly contributes to increased short-term morbidity and mortality. In addition, severe PGD has been associated with higher 90-day and 1-year mortality rates compared with absent or less severe PGD and is a significant risk factor for the subsequent development of chronic lung allograft dysfunction. The International Society for Heart and Lung Transplantation released updated consensus guidelines in 2017, defining grade 3 PGD, the most severe form, by the presence of alveolar infiltrates and a ratio of PaO₂:FiO₂ less than 200. Multiple donor-related, recipient-related, and perioperative risk factors for PGD have been identified, many of which are potentially modifiable. Consistently identified risk factors include donor tobacco and alcohol use; increased recipient body mass index; recipient history of pulmonary hypertension, sarcoidosis, or pulmonary fibrosis; single lung transplantation; and use of cardiopulmonary bypass, among others. Several cellular pathways have been implicated in the pathogenesis of PGD, thus presenting several possible therapeutic targets for preventing and treating PGD. Notably, use of ex vivo lung perfusion (EVLP) has become more widespread and offers a potential platform to safely investigate novel PGD treatments while expanding the lung donor pool. Even in the presence of significantly prolonged ischemic times, EVLP has not been associated with an increased risk for PGD.

原发性移植物功能障碍 (PGD) 是移植后急性肺损伤的一种形式，其特征是低氧血症和再灌注后 72 小时内发生的胸片上出现肺泡浸润。PGD​​ 是肺移植后最常见的早期并发症之一，显着增加了短期发病率和死亡率。此外，与没有或不太严重的 PGD 相比，严重的 PGD 与更高的 90 天和 1 年死亡率相关，并且是随后发展为慢性同种异体肺移植物功能障碍的重要危险因素。国际心肺移植学会于 2017 年发布了更新的共识指南，通过存在肺泡浸润和 PaO _{2的比率来定义最严重的 3 级 PGD}:FiO ₂小于 200。已确定 PGD 的多个供体相关、受者相关和围手术期风险因素，其中许多可能是可改变的。一致确定的风险因素包括供体烟草和酒精的使用；增加接受者体重指数；接受者有肺动脉高压、结节病或肺纤维化病史；单肺移植；以及使用体外循环等。几种细胞途径与 PGD 的发病机制有关，因此为预防和治疗 PGD 提供了几种可能的治疗靶点。值得注意的是，体外肺灌注 (EVLP) 的使用变得更加普遍，并为安全研究新型 PGD 治疗同时扩大肺供体库提供了潜在平台。即使存在显着延长的缺血时间，