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Published on: October 31, 2025
C1-esterase-inhibitor for primary graft dysfunction in lung transplantation
Wiebke Sommer1, Igor Tudorache, Christian Kühn
11 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. 2 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. 3 Member of the German Centre for Lung Research. 4 Department of Anaesthesiology, Hannover Medical School, Hannover, Germany. 5 Address correspondence to: Gregor Warnecke, M.D., Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Member of the German Centre for Lung Research, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
C1-esterase-inhibitor (C1-INH) treatment in lung transplant recipients with early primary graft dysfunction (PGD) showed acceptable outcomes. While survival was lower than controls, it was comparable to severe PGD cases, suggesting C1-INH is a reasonable option.
Area of Science:
- Transplantation immunology
- Critical care medicine
- Pulmonary medicine
Background:
- Primary graft dysfunction (PGD) is a major cause of morbidity and mortality after lung transplantation (LTX), affecting 8-20% of recipients.
- Early identification of severe PGD is crucial for timely intervention.
- C1-esterase-inhibitor (C1-INH) was investigated as a potential therapeutic agent for severe PGD.
Purpose of the Study:
- To evaluate the efficacy of C1-esterase-inhibitor (C1-INH) in attenuating severe primary graft dysfunction (PGD) in lung transplantation (LTX) recipients.
- To compare the outcomes of LTX recipients treated with C1-INH for PGD with those who developed severe PGD without treatment and a control group.
Main Methods:
- A prospective study involving 275 LTX recipients from May 2010 to September 2012.
- Patients with a PaO2/FiO2 ratio < 100 (indicating severe PGD) were treated with C1-INH.
- Comparison groups included patients with severe PGD (PGD3-group) and a general control cohort.
Main Results:
- 24 patients (8.7%) received C1-INH for early PGD.
- C1-INH and PGD3 groups showed significantly higher PGD scores than controls.
- ICU stay was prolonged in C1-INH and PGD3 groups compared to controls (29 days and 9 days vs. 3 days, respectively).
- One-year survival rates were 82.5% for C1-INH group, 71.4% for PGD3 group, and 95% for controls.
Conclusions:
- C1-INH treatment for severe PGD in LTX recipients resulted in acceptable outcomes.
- While survival in the C1-INH group was lower than the general cohort, it was comparable to the severe PGD (PGD3) group.
- C1-INH represents a viable therapeutic option for managing severe PGD post-LTX, aligning with international standards.
