Primary graft dysfunction (PGD or reperfusion edema) develops soon after lung transplant surgery then gradually improves if the patient survives.


Synonyms: ischemia-reperfusion injury, early graft dysfunction, re-implantation response


The process appears around 24 hours after surgery, reaches maximum severity at 3 or 4 days, then improves by the end of the first week after the transplant.


Risk factors:

(1) surgical trauma

(2) donor lung ischemia

(3) interruption of the bronchial circulation

(4) interruption of lymphatic flow


Clinical features:

(1) noncardiogenic pulmonary edema with diffuse pulmonary infiltrate

(2) severe hypoxemia


The diagnosis requires exclusion of other causes.



(1) increased perioperative mortality

(2) decreased long-term survival

(3) progression to bronchiolitis obliterans syndrome (BOS)


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