Therapeutic agents for the prevention of primary graft dysfunction after lung transplantation: A comprehensive narrative review.

Primary graft dysfunction (PGD) remains the leading cause of morbidity and mortality following lung transplantation. This narrative review explores current evidence regarding pharmacological strategies for the prevention and management of PGD. A comprehensive literature search identified randomized controlled trials and clinical studies evaluating therapeutic agents targeting ischemia-reperfusion injury and inflammatory pathways. Interventions assessed include inhaled nitric oxide, surfactants, complement inhibitors, platelet-activating factor antagonists, and novel anti-inflammatory agents. Despite promising preclinical data, most trials failed to demonstrate statistically significant improvements in clinical outcomes, primarily due to small sample sizes and methodological heterogeneity. Current PGD management remains supportive and modeled on acute respiratory distress syndrome (ARDS) principles. Future research should focus on multicenter, adequately powered studies testing multimodal strategies combining pharmacologic and procedural interventions. Preventing PGD will be essential to improving early survival and long-term graft function in lung transplant recipients.