**5.3 Rescue from primary graft dysfunction (PGD)**

Primary graft dysfunction is identified when the transplanted allograft fails to function adequately in the early postoperative period [19]. PGD may be at least partially attributable to ischemia-reperfusion injury of the graft, immunological response and from a combination of other host and donor factors. It is recognized as a low cardiac output state, with potentially pulmonary edema and/ or arrhythmias. The right ventricle, left ventricle, or biventricular involvement can occur. Initial management involves expansion of intravascular volume and use of inotropes; however these may not suffice and, unhindered, may lead to multiple organ dysfunction. Rescue treatment by use of VA ECMO support maintains perfusion and oxygenation while the graft recovery occurs. Peripheral cannulation support in PGD was associated with better survival then central [20].
