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Ann Thorac Surg 1992;54:1071-1077
© 1992 The Society of Thoracic Surgeons

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Articles

Early cellular events in the lung allograft

The Joint Marseille-Montreal Lung Transplant Program, Montreal, Quebec, Canada

^_* Address reprint requests to Dr Shennib, The Joint Marseille-Montreal Lung Transplant Program, Montreal General Hospital, 1650 Cedar Ave, Montreal, Que, Canada H3G 1A4.

We hypothesized that ischemic insult to the lung allograft may render it more susceptible to rejection. Left canine single-lung allografts were subjected to usual periods of cold and warm ischemia (4 hours and 1 hour, respectively). Bronchoalveolar lavage and open lung biopsies were performed at 0,1, 4, and 24 hours and 1 week after transplantation. Bronchoalveolar lavage fluid was examined for cellular phenotypes, lymphocyte lectin-mediated cytotoxicity, and natural killer cell cytotoxicity. Open lung biopsy specimens were examined for severity of injury/rejection and MHC class II expression. Within 1 to 4 hours of reimplantation, we observed marked influx of polymorphonuclear leukocytes and lymphocytes and an increase in lectin-mediated cytotoxicity (25.6% ± 14.8% and 50.6% ± 20.1% versus 5.4% ±7.5% preoperatively; (p < 0.05). In addition, natural killer cell cytotoxicity increased from 10.2% ± 13.5% before transplantation to 20.5% ± 8.6% 4 hours after transplantation (p < 0.03). By 24 hours MHC class II expression became evident and continued to increase while subtle histologic evidence of rejection appeared by 1 week. We conclude that ischemia-reperfusion injury can alter the local bronchopulmonary milieu, thus rendering it more susceptible to the development of rejection.

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