Acute graft dysfunction reperfusion injury

Acute deterioration of graft function often occurs in lung transplant recipients over the first 24 to 48 h postoperatively. It is attributed to a combination of suboptimal donor lung preservation, ischemic injury, and reperfusion injury. The end result is rapid development of non-cardiogenic pulmonary edema and pulmonary infiltrates. Clinical suspicion should be raised by rapid deterioration in gas exchange with decrease in arterial oxygen saturation, decrease in lung compliance, increase in pulmonary vascular resistance, and unilateral radiological changes resembling the acute respiratory distress syndrome. Fortunately, in the majority of cases, this process responds to aggressive diuretic therapy and adjustment in ventilatory settings by adding or increasing peak end-expiratory pressure. Prevention of acute early graft dysfunction is the main reason for the limit of 4 to 6 h in graft ischemic time recommended in lung transplantation.

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