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HYPOTHESIS AND THEORY article

Front. Transplant.
Sec. Thoracic Transplantation
Volume 3 - 2024 | doi: 10.3389/frtra.2024.1422088

Mitigating the Risk of Inflammatory Type Primary Graft Dysfunction by Applying an Integrated Approach to Assess, Modify and Match Risk Factors in Lung Transplantation

Provisionally accepted
Sue Braithwaite Sue Braithwaite 1*Elize M. Berg Elize M. Berg 1Linda De Heer Linda De Heer 1Jitte Jennekens Jitte Jennekens 1Arne Neyrinck Arne Neyrinck 2Elise van Hooijdonk Elise van Hooijdonk 1Bart Luijk Bart Luijk 1Wolfgang F. Buhre Wolfgang F. Buhre 1Niels Van Der Kaaij Niels Van Der Kaaij 1
  • 1 University Medical Center Utrecht, Utrecht, Netherlands
  • 2 University Hospitals Leuven, Leuven, Brussels, Belgium

The final, formatted version of the article will be published soon.

    Long-term outcome following lung transplantation remains one of the poorest of all solid organ transplants with a 1-and 5-year survival of 85% and 59% respectively for adult lung transplant recipients and with 50% of patients developing chronic lung allograft dysfunction (CLAD) in the first 5 years following transplant. Reducing the risk of inflammatory type primary graft dysfunction (PGD) is vital for improving both short-term survival following lung transplantation and long-term outcome due to the association of early inflammatorymediated damage to the allograft and the risk of CLAD.PGD has a multifactorial aetiology and high-grade inflammatory-type PGD is the result of cumulative insults that may be incurred in one or more of the three variables of the transplantation continuum: the donor lungs, the recipient and intraoperative process.We set out a conceptual framework which uses a fully integrated approach to this transplant continuum to attempt to identify and, where possible, modify specific donor, recipient and intraoperative PGD risk with the goal of reducing inflammatory-type PGD risk for an individual recipient. We also consider the concept and risk-benefit of matching lung allografts and recipients on the basis of donor and recipient PGD-risk compatibility.The use of ex vivo lung perfusion (EVLP) and the extended preservation of lung allografts on EVLP will be explored as safe, non-injurious EVLP may enable extensive inflammatory testing of specific donor lungs and has the potential to provide a platform for targeted therapeutic interventions on lung allografts.

    Keywords: Lung Transplantation, Primary Graft Dysfunction, PGD risk matching, Immunomodulation, EVLP, extended EVLP, donor lung allocation

    Received: 23 Apr 2024; Accepted: 08 Jul 2024.

    Copyright: © 2024 Braithwaite, Berg, De Heer, Jennekens, Neyrinck, van Hooijdonk, Luijk, Buhre and Van Der Kaaij. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Sue Braithwaite, University Medical Center Utrecht, Utrecht, Netherlands

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.