Background: Lung transplantation (LTx) represents the primary therapeutic recourse for individuals with end-stage lung disease. Despite advancements in the field, primary graft dysfunction (PGD) persists as the foremost cause of early mortality post-transplantation, setting the stage for chronic lung allograft dysfunction (CLAD), a pivotal factor contributing to delayed mortality subsequent to LTx. PGD typically manifests within the initial 72 hours post-transplantation, compromising lung oxygenation capacity, as measured by the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio. Augmenting this ratio assumes paramount importance and is intricately linked with enhanced survival rates.
Effective treatments for PGD remain elusive, contributing to the clinical challenge in managing this condition. When a transplanted lung encounters rejection by the recipient's immune system, an inflammatory cascade ensues, with cytokines assuming a pivotal role in the initiation, amplification, and perpetuation of the inflammatory process culminating in PGD. Cytokine filtration emerges as a promising strategy aimed at mitigating inflammation by eliminating these cytokines from circulation.
In a proof-of-concept preclinical porcine model simulating LTx, cytokine filtration demonstrated notable efficacy, resulting in improved oxygenation levels and mitigated PGD severity.
Objective: The purpose of this clinical trial is to demonstrate the superiority of cytokine filtration in improving LTx outcome, based on its effects on oxygenation ratio, plasma levels of inflammatory markers, PGD incidence and severity, lung function but also safety. 
Method: Interventional randomized controlled trial involving 20 patients. Its primary objective is to investigate the safty but also the potential benefits of cytokine filtration when used in conjunction with LTx. Specifically, this study aims to determine whether the application of cytokine filtration, administered during the transplantation and for a duration of 12 hours within the initial 24 hours following a LTx procedure, can lead to improved patient outcomes.
Results: Treated patients exhibited higher PaO2/FiO2 ratios and lower incidences of PGD, as well as fewer histopathological signs of acute rejection at 1- and 3-month post-transplant compared to patients without the adsorber.
Conclusions: Utilizing a cytokine adsorber during transplantation may result in a reduced systemic inflammatory state, leading to lower incidences of PGD and supporting graft acceptance. These findings underscore the potential of cytokine filtration as a therapeutic approach for managing PGD and enhancing post-transplant outcomes.