Prevention and treatment of primary graft dysfunction after lung transplantation (108 cases report) / 中华器官移植杂志

ABSTRACT

ObjectiveTo evaluate the prevention and treatment of primary graft dysfunction (PGD) after lung transplantation (LTx).MethodsWe retrospectively analyzed clinical data of108 cases of lung transplantation from September 2002 to June 2011. All the recipients were given continuous monitoring of invasive arterial pressure,pulmonary artery pressure and (or) central venous pressure and artery blood gas analysis and chest X-ray examination postoperatively.The negative fluid balance of the recipients in the first 3 days was maintained.The inspired oxygen (FiO2) or ventilator parameters was adjusted according to the arterial oxygen tension (PaO2) and (or) oxygen saturation,to prevent the occurrence of PGD.Once PaO2/FiO2 sharp decline (less than 200),and chest X-ray showed higher density of the lower transplanted lung fields in the early postoperative period,PGD could be diagnosed when acute rejection,venous anastomotic obstruction,cardiogenic pulmonary edema and pulmonary infections were excluded.According to the standards set by the International Association of Heart and Lung Transplantation,PGD is divided as 0,1,2 and 3.Different levels of PGD were treated by ventilatory support,negative fluid balance,extending the treatment time of the ventilator,the use of pulmonary vasodilators,such as prostaglandin E1and the use of ECMO.Results PGD occurred in10 cases,and the incidence rate was 9.3％. 6 cases were given conventional ventilatory support for (285.8 + 238.6) h (Two cases obtained reversal of PGD,and four cases died) ; the rest four cases were given ECMO (Two cases were supported by ECMO in 24 h after the occurrence of PGD and had a long-term survival after a successful reversal of PGD,and the rest two cases died from acute renal failure and multiple organ failure induced by PGD on the 8th and11th day of the application of ECMO due to the late application of ECMO (after 24 h).ConclusionThe high incidence of PGD causes high mortality perioperatively after lung transplantation.Preventing PGD can improve the survival rate of the lung transplant patients.Once PGD happens,appropriate treatment should be given as soon as possible.