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The Annals of Thoracic Surgery, Vol 54, 1071-1076, Copyright © 1992 by The Society of Thoracic Surgeons
R Adoumie, C Serrick, A Giaid and H Shennib
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.
ARTICLES
Early cellular events in the lung allograft
Joint Marseille-Montreal Lung Transplant Program, Quebec, Canada.
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