Incidence of primary graft dysfunction after lung transplantation is altered by timing of allograft implantation

Cunningham PS¹, Maidstone R¹, Durrington HJ^1,2, Venkateswaran RV^1,3, Cypel M⁴, Keshavjee S⁴, Gibbs JE¹, Loudon AS¹, Chow CW⁴, Ray DW^1,5,6, Blaikley JF^1,2,3. (Toronto, Oxford & Manchester)

Thorax. 2018 Oct 9. pii: thoraxjnl-2018-212021. doi: 10.1136/thoraxjnl-2018-212021. [Epub ahead of print]

The importance of circadian factors in managing patients is poorly understood. We present two retrospective cohort studies showing that lungs reperfused between 4 and 8 AM have a higher incidence (OR 1.12; 95% CI 1.03 to 1.21; p=0.01) of primary graft dysfunction (PGD) in the first 72 hours after transplantation. Cooling of the donor lung, occurring during organ preservation, shifts the donor circadian clock causing desynchrony with the recipient. The clock protein REV-ERBα directly regulates PGD biomarkers explaining this circadian regulation while also allowing them to be manipulated with synthetic REV-ERB ligands.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. KEYWORDS: lung transplantation; macrophage biology PMID: 30301818 DOI: 10.1136/thoraxjnl-2018-212021
Full text at: https://thorax.bmj.com/content/early/2018/10/09/thoraxjnl-2018-212021.long